Q: We’ve already conducted basic ICD-10 training for our coders. What steps do we take next?
A: Congratulations on finishing basic training. I applaud your success. Assuming you’ve already provided biomedical remediation to your coders, there are four more steps to get beyond the basics.
Step One: Measure Coder Competency
Ask yourself how well your coders are performing following their basic training. Did the training result in expected outcomes? For example, using actual patient charts and existing clinical documentation, measure how accurate your coders are today. Simply coding a diagnostic statement is not the same as coding an actual patient’s chart.
Double coding or dual coding is the best way to assess coder competency thus far with ICD-10. Coding roundtables should also be conducted at this point to discuss diagnostic specificity, root operations, approaches, and body parts. ICD-10-PCS is tricky — it is not your grandmother’s coding system!
Step Two: Measure Coder Productivity and Impact on Accounts Receivable
Some experts have predicted a 40 percent decrease in coder productivity with ICD-10. And that’s assuming your team is working cohesively and everyone knows exactly what to do within the new coding structure. A big assumption! Instead of assuming, take the time now to accurately predict future productivity. There are four questions to ask and factor into coder productivity estimates.
- Physician documentation — is it already prepared for ICD-10?
- Mounting pressures on coders — will they experience performance anxiety? What other tasks can you offload?
- Payers and the adjudication process — how will a spike in denials and rejections impact your coding team?
- Lack of system cohesiveness — will IT systems be integrated or will coders need to navigate multiple systems?
Address these four issues now. Failing to do so could result in significant productivity and AR concerns.
Step Three: Secure Coding Auditors
One of the biggest challenges in ICD-10 will be the availability of coding auditors. Where will you find “experts” to audit your coding team’s work? Are you developing internal auditors or will you need to secure an outside coding audit partner?
If it is your job to manage the coding audit process within your facility, now is the time to ensure that your internal auditors receive advanced ICD-10-CM/PCS training.
If external coding auditors will be used, stay one step ahead of the tsunami! Get your external coding and coding audit partners engaged now, build a high level of trust, and ensure their availability for 2015.
Step Four: Provide Direction
Finally, be sure to update your ICD-10 training plans including dual coding, additional learning experiences for coders, CDI collaboration efforts to build physician trust, and end-to-end testing with real cases as discussed in our last ICD-10 Intelligence Q&A.
Communicate new plans with your coding team and executive leadership. Keeping everyone informed and aware reduces fear and helps to ensure a more successful ICD-10 implementation in 2015.
Sallee Silverman met HRS founder Wendy Coplan-Gould in 1979 when they both worked as ICD-9 trainers. Thirty years later, Sallee is an ICD-10 trainer, helping providers and payers navigate the upcoming transition. Sallee has managed coding outsourced operations for HRS and provided data quality consulting. She helps clients with ICD-10 implementation, training and clinical documentation improvement projects.
