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ICD-10-CM/PCS
Education . . . How to Begin
Kathryn DeVault, RHIA, CCS, CCS-P
Director, HIM Solutions, AHIMA
Agenda
• Benefits of ICD-10-CM/PCS transition
• Organizational ICD-10 Education
• HIM ICD-10 Education
• Preparation for Education
• Coding Staff Education
• Impact to HIM/Coding Staff
Benefits of ICD-10-CM/PCS
• Higher quality data
– Improved ability to measure the quality,
efficacy, and safety of patient care
– Increased sensitivity when refining grouping
and reimbursement methodologies
– Enhanced ability to conduct public health
surveillance
– Benefits from EHR adoption
Benefits of ICD-10-CM/PCS
• Improved efficiencies/ lower administrative
costs
– Automated tools to facilitate coding
– Decreased claims adjudication costs
– Fewer miscoded and rejected claims
– Improved resource management
– Reduced labor costs
– Increased productivity
ICD-10 Implementation Plan AHIMA’s ICD-10 Preparation
5
Checklist: http://www.ahima.org/icd10/ICD-10PreparationChecklist.mht
2009/ 2010 2011 2012 2013
Implementation Plan
Development/Impact
Assessment
Implementation Preparation
Go Live
Preparation
Post –
Implementation
Phase I
Phase II
Phase III
Phase IV
Year
WHO Needs ICD-10-CM/PCS
Education?
Organizational Education
• Multiple categories of users of coded data
• Require varying types and levels of ICD-
10 education
• Education will be needed at different times
• Determine:
– WHO needs education
– WHAT type of education
– WHEN they need education
Organizational Education
Training needs cannot
be assessed until all
affected business
areas and
individuals have
been identified
Categories of Users • Coders
• Other HIM staff
• Clinicians
• Senior management
• IT staff
• Quality management
• Utilization management
• Accounting
• Business office
• Auditors/consultants
• Patient registration
• Other data users
• Clinical department Mgrs
• Ancillary departments
• Data analysts
• Researchers
• Epidemiologists
• Performance
improvement
• Corporate compliance
• Data quality management
• Data security
• CDI staff
• Payer contract managers
• Registry personnel
Organizational Education
• Identify most appropriate and cost-
effective methods for education
– Traditional face-to-face classroom
– Audio conferences
– Self-directed learning programs
– Self-directed or instructor-led Web-based
instruction
– Internal or external mechanisms or a
combination of both
Organizational Education
• Develop organization-wide ICD-10
awareness education
– Senior Management
– IT personnel
– Clinical department managers
– Medical staff
– Other data users
• Provide the right training at the right time
Awareness Education
• Senior Management
– Regulatory requirements
– Value of new code sets
– How ICD-10 fits with other initiatives
– Transition effects on operations
– Impact on coding productivity and accuracy
– Budgetary considerations
– Impact on legacy data
Awareness Education
• IT Personnel
– Regulatory requirements
– Value of new code sets
– How ICD-10 fits with other initiatives
– Budgetary considerations
– Implementation plan (including testing
schedule)
– Code set specifications
Awareness Education
• Additional IT education needs:
– Awareness of code set specifications
• Date-of-service-driven
• ICD-10-PCS replacing only ICD-9-CM procedure
codes used for facility reporting of inpatient
services
• Character-length specifications
• Numeric versus alphanumeric format
• Use of decimals
• Availability of codes, descriptions, and applicable
support documentation and guidelines in machine-
readable form
Awareness Education
• Additional IT education needs:
– Determine how long dual codes sets will be
maintained
• Claims for services before the ICD-10 compliance
date
• Historical data for analysis
• Locations or applications that will house historical
data, the resource implications, and who will have
access
Awareness Education
• Clinical Department Managers
– Regulatory requirements
– Value of new code sets
– How ICD-10 fits with other initiatives
– Impact on legacy data
– Differences between ICD-10-CM and ICD-10-
PCS
– Impact on each department and budgetary
considerations
Awareness Education
• Medical Staff
– Regulatory requirements
– Value of new code sets
– How ICD-10 fits with other initiatives
– Impact on legacy data
– Impact on documentation practices
– Implementation plan and how it will be
adapted
– Impact on individual physicians
Awareness Education
• Other Data Users:
• Case Management, Utilization
Management, Quality Management, Data
Analysts
– Differences in the classification of diseases
and procedures in ICD-10
– Data comparability issues and the effect on
longitudinal data analysis
– GEMs and their role in the ICD-10 transition
process
HIM ICD-10-CM/PCS
Education
ICD-10-CM/PCS Education
• HIM Managers
– Regulatory requirements
– Value of new code sets
– How ICD-10 fits with other initiatives
– Impact on legacy data
– Key provisions of final rule
– Structure, organization, and unique features
of ICD-10-CM/PCS
ICD-10-CM/PCS Education
• Coding Staff (Initial education)
– Regulatory requirements
– Value of new code sets
– How ICD-10 fits with other initiatives
– Impact on legacy data
– Key provisions of final rule
– Structure, organization, and unique features
of ICD-10-CM/PCS
Preparation for
Education
Preparation for Education
• Gap analysis of coding staff knowledge
– Assess staff knowledge in biomedical
sciences
• Anatomy & Physiology
• Pathophysiology
• Medical Terminology
• Pharmacology
– Refresh staff knowledge based on
assessment results
Preparation for Education
• Contract coding staff
– Ensure contract coding staff being prepared in
ICD-10 coding
– Identify their strategy and timeline for coder
training
– Identify competence of contract coding staff
Preparation for Education
• Quality of medical record documentation
– Evaluate samples of various types of medical
records
• Does documentation support level of detail found
in ICD-10?
– Sampling techniques:
• Random samples
• Most frequent diagnoses or procedures
• Known documentation problems with ICD-9
Preparation for Education • Implement documentation improvement
strategies to address problem areas
– Consider changes in documentation capture
processes
– Educate medical staff
• Findings of medical record review
• Identify documentation elements needed in ICD-10
• Provide specific examples
• Emphasize the value of concise data capture for
high-quality data
• Assess the impact on coding and billing
productivity
Education of Coding Staff
• Increase familiarity with ICD-10 code sets
• Increase familiarity with associated coding
guidelines
• Continue education in biomedical sciences
to address deficiencies identified in gap
analysis
• Inpatient coders should become familiar
with ICD-10-PCS definitions
Education of Coding Staff
• General Equivalence Mappings (GEMs)
– Provide training on the use of the GEMs
– Identify mapping processes
– Identify mapping technology
• Critical for those involved in data-
conversion projects
To Be Considered . . . .
Impact in HIM/Coding
• Decreased coding productivity
– Assess impact of decreased productivity
on organization’s accounts receivable
status
• How long is decline expected to last?
• What steps can be taken to reduce effect
on decreased productivity?
Coding Productivity • Reduce effect of decreased productivity:
– Eliminate coding backlogs before
implementation
– Use contract personnel to assist with
workload during period after implementation
– Prioritize records to be coded
– Ensure adequate ICD-10 education and
provide refresher training
– Assess documentation and implement
improvement strategies
– Use electronic tools to support coding process
Coding Accuracy
• Impact of decreased coding accuracy
– What is the anticipated effect on coding
accuracy?
– How long will it take for coding staff to achieve
ICD-10 proficiency
– What steps should be taken to improve
coding accuracy?
• Assess coding knowledge and skills
• Provide an appropriate level of education
Coding Accuracy
• Monitor coding accuracy closely during
implementation
• Provide additional education as indicated
• Identify other potential problems or
challenges
– Implement strategies aimed at reducing
potential negative effect