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The healthcare community has expressed concern about the cost of training and the potential loss of coding productivity due to the implementation of ICD-10-CM and ICD-10-PCS. Some experts have predicted a loss of productivity between 10 and 50 percent. Many facilities are concerned about recruiting and retaining qualified coding professionals to lead this initiative

All of these concerns are real, but there should not be a “one size fits all” approach to training for ICD-10-CM and ICD-10-PCS.

ICD-10-CM Training

Because all healthcare providers will be moving to ICD-10-CM for diagnoses coding, most of the dialogue has been centered on training for ICD-10-CM. Hospitals, physician offices, payers—literally all of healthcare will be implementing ICD-10-CM on October 1, 2014. Although the ICD-10-CM code set provides more specificity and looks different (alphanumeric), some people are operating under the assumption that it is a different classification than ICD-9-CM. ICD-10-CM is a new version of ICD-9-CM, not a new system. With a few exceptions, the guidelines are the same and the integrity of the classification system remains intact. The big changes in ICD-10-CM include:

  • Use of seventh characters for injuries/poisonings, external causes, and obstetrics section.
  • Change in method for reporting aftercare of injuries.
  • Time frame changes for acute myocardial infarction and fetal deaths.
  • Use of laterality.

Coders who can transfer their ICD-9-CM knowledge and skill set can easily assign a code in ICD-10-CM without major educational efforts. The coding process and principles have not changed. The bottom line is that if a coder has good working knowledge of ICD-9-CM, ICD-10-CM should be a walk in the park. If a coder uses a cheat sheet and had minimal training on ICD-9-CM, the transition will be more difficult. An assessment process will help efforts to provide training for the different levels of knowledge and skill for coding professionals.

ICD-10-PCS Training

Unlike ICD-10-CM, ICD-10-PCS is an entirely new system for coding inpatient procedures. The coding system is not like CPT or the third volume of ICD-9-CM. The seven-character code provides granularity not available with any other procedural coding system. The design of the system allows for flexibility and can easily be updated to capture new techniques and advancements in surgical procedures. ICD-10-PCS will replace the current classification, but the Centers for Medicare & Medicaid Services (CMS) is only requiring the codes for inpatient procedures. Coding experts say a short seminar or weekend workshop will not make even an experienced coder proficient with using ICD-10-PCS. The first step in the educational plan will be to master the guidelines and differentiate between the 31 root operations, the foundation for classifying procedures in ICD-10-PCS.

Coding professionals must have a strong knowledge of anatomy, be able to analyze documentation to support coding decisions, and have working knowledge of how surgical procedures are performed. Those familiar with reading operative reports for CPT coding may have an easier task in learning ICD-10-PCS, but toggling between the two systems might be challenging. Integrating this knowledge of surgical techniques and using case studies (operative reports) allows coders to apply their knowledge and discover their gaps. Filling the gaps is vital for grasping the system. Coding professional on this path have said the following focused educational plan has helped them achieve success with ICD-10-PCS:

  • Having coding roundtable meetings.
  • Participating in formal assessment process.
  • Holding weekly practicum sessions using their facilities’ own operative reports.
  • Attending advanced educational sessions.
  • Tackling the top 10 or 20 inpatient procedures in the facility and grasping the surgical technique that translates into an ICD-10-PCS code.
  • Sharing best practices and resources.

This educational plan works well for a general medical-surgical community hospital; however, large teaching facilities and Level I trauma centers will require a longer training schedule with advanced skill building.

One of the hurdles for ICD-10-PCS training is to find coding experts in the field who are willing and able to conduct advanced sessions and can lead coders to achieving their educational goals. As the October 2014 implementation date nears, it will be harder to find external support; developing internal ICD-10-PCS champions needs to happen now. These champions should have good communication skills and the ability to package the concepts for the learners.

Many sources have declared that coding training needs to occur six to nine months before implementation. This timeline may be true for ICD-10-CM training; however, the training for ICD-10-PCS needs to start immediately. The healthcare community should not underestimate this major change to the inpatient procedural coding system.

© 2013 CCH, Incorporated

About the Author

Maria T. Bounos, RN, MPM, CPC-H, is the practice lead for coding and reimbursement software solutions for Wolters Kluwer.  Maria began her career at Wolters Kluwer as a product manager, responsible for product development, maintenance, enhancements and business development and now solely focuses on business development.  She has more than twenty years of experience in healthcare including nursing, coding, healthcare consulting, and software solutions.

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