The next nine months are critical in terms of preparing for a smooth transition to ICD-10. If ICD-10 isn’t a priority in your organization yet, it should quickly rise to the top of the list as soon as possible. Health information management (HIM) professionals must lead the charge to ensure that everyone understands the timelines and tasks that must be accomplished facility-wide to make ICD-10 a reality. Given the fact that the clock is ticking, organizations must prioritize their efforts to make the most of the time remaining between now and Oct. 1.
Although specific priorities may vary from organization to organization based on overall readiness, the following areas should be front and center throughout the remainder of ICD-10 preparations:
ICD-10 communication efforts. Everyone needs to know that ICD-10 is coming, and it’s coming soon. The next nine months will fly by, and procrastination is any organization’s worst enemy. A strong communication and ICD-10 marketing plan is essential. Does your organization have an internal newsletter? If so, ensure that ICD-10 is mentioned in every issue. Post ICD-10-related signs and reminders in the cafeteria, elevators, and physician areas. Once a particular milestone is met, send a congratulatory email. Ensure that clinical documentation improvement (CDI), physicians, coders, HIM management, and administration meet regularly, at least every other week, to communicate goals and updates.
Coder refresher training. Build time for refresher training into coders’ schedules on a daily or weekly basis. This could include requiring coders to review ICD-10 guidelines, read articles about ICD-10, listen to audio conferences, take online courses, discuss ICD-10 cases as a group, and/or engage in a variety of methods to keep ICD-10 knowledge fresh in the mind. Keep in mind that the type and frequency of refresher training may vary from coder to coder. For example, one coder may need ongoing anatomy and physiology refresher training, while another might require focus specifically on PCS root operations. Ask coders to be mindful of the areas in which they feel they could benefit from additional education, and then aim to provide them with the resources they need to feel more confident.
Coder practice time. Coders must also be able to practice ICD-10 as much as possible. Many organizations are dual coding records not only to give coders experience with ICD-10, but also to identify potential documentation gaps that can be addressed with physicians. Some hospitals allow one coder per day to practice ICD-10 while others focus on current cases in ICD-9. Others allow all coders to practice ICD-10 one hour per day or one afternoon per week. Ensure that coders use actual medical records from their own facility when they practice. This is far more productive and realistic than applying ICD-10 codes to a fictitious record or simple diagnostic statement.
HIM directors may feel as though there simply aren’t enough hours in the day to build practice time into coders’ schedules; however, this mindset is short-sighted and will only negatively impact organizations once ICD-10 takes effect. Consider hiring outsourced coders who can cover current cases while internal staff members are freed up to practice. Also consider extending the workday to include evenings and weekends with overtime pay.
Specialty-specific physician education. If organizations haven’t already begun to revise queries and electronic health record (EHR) templates to include the specific details necessary for ICD-10, they should begin to do so now. They should also provide ongoing educational sessions to physicians about the documentation requirements pertaining to their specific specialties. These sessions should be brief and only include what physicians need to know about how their documentation will need to change.
Information gleaned from dual coding and CDI specialist input should drive physician education. Consider developing a formal process for obtaining documentation feedback resulting from dual coding and CDI efforts. As coders identify documentation gaps, how do they record them, and to whom do they send information? Do CDI specialists communicate regularly with coders to compare notes and to ensure that all bases are covered?
Staffing needs. HIM directors and managers must plan for the anticipated decrease in coder productivity. Those who choose to ignore this will be left scrambling for scarce resources in October and may face the wrath of administrators who become frustrated with a rising DNFB. Consider the following tips to address staffing concerns:
- Invest in coders now. Can you put into place retention strategies mandating that coders are required to stay with the organization for at least a year after ICD-10 implementation? Can you provide bonuses or pay overtime for extra hours worked?
- Ensure that your salaries are competitive. How does a coder’s salary at your organization compare with that of others in the area? Does your organization offer other benefits that entice coders to stay? Ask coders what they want. Can you cater to these desires in any way?
- Hire extra coders. If you anticipate needing at least one FTE, begin the job search now. Finding the right candidate could take some time. Look for someone who has a thirst for knowledge and who will be driven and dedicated to the organization.
- Consider remote coding. Remote coding allows organizations to expand their potential pool of candidates, and it can also serve as a valuable retention tool to keep current staff members happy.
- Talk with your vendors. Ensure that your vendors can adjust to fluctuations in workflow. Also, don’t rely entirely on one vendor. It may not be reasonable to expect that one vendor can always meet an organization’s needs. Contact various vendors so that you always have a backup in the event that work volume changes suddenly. The more information about your needs you can provide the vendors, the better. What do you anticipate your productivity losses will look like, and for how long will they last? How does this translate into additional FTEs necessary to maintain your current volume? Organizations may require several FTEs, particularly in the beginning of the ICD-10 transition, just to maintain current volumes. This is especially true for those entities in which complex procedures are performed regularly.
Staying on track
If, after reading this article, you feel overwhelmed — don’t panic! There’s plenty of time to dig your heels in and achieve ICD-10 success within your organization. Get administration on board as soon as possible so they can give you the financial support and system-wide cooperation you need. This ensures that physicians and ancillary services make the initiative a priority. Don’t let the potential for another delay fool you. Stay focused on the top five priorities, and you can’t go wrong.
About the Author
Cathie Wilde, RHIA, CCS, is the director of coding services for MRA. Ms. Wilde has been active in the healthcare industry for more than 30 years. Her previous positions have included assistant director of HIM, DRG coordinator at the Massachusetts Hospital Association, and DRG validator at Blue Cross Blue Shield. She has extensive experience in ICD-9-CM and CPT coding, auditing, data analysis, development and testing of coding products, specialized reporting, and in-service training. As director she is responsible for overseeing the coding division, providing the strategic direction of MRA as a local industry leader of quality coding, auditing, and denial management services. Ms. Wilde is an American Health Information Management Association (AHIMA)-approved ICD-10-CM/PCS trainer.
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