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ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, CCS, CCS-P Director, HIM Solutions, AHIMA

ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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Page 1: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

ICD-10-CM/PCS

Education . . . How to Begin

Kathryn DeVault, RHIA, CCS, CCS-P

Director, HIM Solutions, AHIMA

Page 2: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 3: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 4: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 5: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 6: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

WHO Needs ICD-10-CM/PCS

Education?

Page 7: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 8: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

Organizational Education

Training needs cannot

be assessed until all

affected business

areas and

individuals have

been identified

Page 9: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 10: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 11: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 12: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 13: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 14: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 15: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 16: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 17: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 18: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 19: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

HIM ICD-10-CM/PCS

Education

Page 20: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 21: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 22: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

Preparation for

Education

Page 23: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 24: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 25: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 26: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 27: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 28: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 29: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

To Be Considered . . . .

Page 30: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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?

Page 31: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 32: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 33: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency

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

Page 34: ICD-10-CM/PCS Education . . . How to Begin · ICD-10-CM/PCS Education . . . How to Begin Kathryn DeVault, RHIA, ... Assessment Implementation ... ICD-10 proficiency