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Jan 6, 2014 ... Paul Weygandt, MD, JD, MPH, MBA, CPE, vice president of physician services at ... Most errors in the HIMSS/WEDI test “were function- al [ones] ...
ICD-10-CM/PCS

Implementation year begins with dual coding Has your coding department begun dual coding ICD-9 and ICD-10-CM/PCS? If your answer is no, or if you don’t know when your facility plans to start dual coding, you could be already behind the curve. According to a December 2013 poll on the ACDIS website (http://tinyurl.com/okwba9a), 45% of respondents expected their facility to begin dual coding in January, and another 17% indicated they expect to begin in April. “If you have one New Year’s resolution, make it dual coding,” says Mary H. Stanfill, MBI, RHIA, CCS, CCS-P, FAHIMA, vice president of HIM consulting services for United Audit Systems, Inc., in Cincinnati, and AHIMAapproved ICD-10-CM/PCS trainer. Why? Because you cannot improve on an unknown, says Paul Weygandt, MD, JD, MPH, MBA, CPE, vice president of physician services at J.A. Thomas and Associates, Inc., a Nuance company. “You need to do an assessment today. If you don’t, then you are not going to have any idea how you will perform under ICD-10.”

“You need to do an assessment today. If you don’t, then you are not going to have any idea how you will do with ICD-10.” —Paul Weygandt, MD, JD, MPH, MBA, CPE Yet every facility differs, Stanfill says, and every program’s transition plans need to reflect not only the priorities of the hospital but also the program’s CDI and coding focus areas. “We may think that everyone has already started dual coding, but in reality some are starting January 1 and others are waiting to start in March or April,” she says. Other facilities are planning to use contracted or consulting staff to code a percentage of records using ICD-9-CM, freeing up internal coders to practice reviewing records for ICD-10-CM/PCS. As an example, Stanfill cites one facility that used a consulting firm to gradually take on more and more of the facility’s ICD-9-CM coding over the course of 2014. By the

October 1 ICD-10 implementation, the firm will be coding 100% of the ICD-9 records. “Those types of plans and the rates of records reviewed will be very particular to a facility’s needs and where they are in their implementation strategies,” she says. The value of dual coding comes from the practical application of the code set and the lessons learned in advance of the go-live date, says Stanfill. “It may sound basic, but you have to see whether the coders know how to apply the new code set, to see where existing efforts are. If the coders have received training and yet are not comfortable using the code set or aren’t using it accurately, you have time to iron that out, but if you don’t start looking at it now you won’t have time to work through those kinks during go-live,” she says. Study shows coding accuracy improvements needed

An October 2013 report from the Health Information and Management Systems Society (HIMSS) and the Workgroup for Electronic Data Interchange (WEDI) tested coders’ efficiency in the new code set. The report concluded that even though the volunteer coders were AHIMA-approved ICD-10 trainers from various facilities, they had an average accuracy rate of just 63%. (See the full report at http://tinyurl.com/pk36lds.) Anecdotally, Stanfill relates the experiences of one facility, which provided online ICD-10-CM/PCS training to its staff and then handed them records to code. “They didn’t know how to do it,” she says. The facility had to hire additional trainers to come in and provide extra ­education. During the second round of training, “you could see the light bulbs going off all over the room,” she says. “If you start now, there will be plenty of time to circle back and provide extra education later on for the trouble spots.” Most errors in the HIMSS/WEDI test “were functional [ones],” according to the report, such as case numbers not matching up appropriately or mistakes made due to other administrative errors. However, the study also highlighted some interesting

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areas for potential targeted improvement. The study took redacted records and grouped them in “waves.” In the pilot, the term “wave” was used to mean “scheduled phases” in which each set of medical test cases were sent to each of the participating organizations. Each “wave” could contain upwards of 10 or more clinical scenarios. For example, scenario 19 in “wave 1” was for a case related to ICD-9 code 250.40, diabetes with renal manifestations, Type 2 or unspecified type, not stated as uncontrolled; this scenario had an accuracy rate of 38%. Scenario 73 in “wave 11” related to ICD-9 code 486, pneumonia only, and had an accuracy rate of 58%. (View the coding efficiency rates and their example medical records online at http://tinyurl.com/nqz9htq.) “These were real clinical scenarios,” says Rhonda Taller, BA, MHA, principal consultant for Siemens Healthcare, who was involved in the report’s creation and worked with the study group that organized the program during a December 2013 “Talk Ten Tuesday” podcast. Working through actual medical records to test coder effectiveness is a vital piece of program preparedness, says Mark Lott, principal of Lott QA Group, who is conducting national testing of the new code set. “You need to go over your own records and see how many times the coders get the right answers across all records,” says Lott, who also spoke during the “Talk Ten Tuesday” session. Canned scenarios are not optimal training tools, he says. And don’t rely on the general equivalency mapping systems, or GEMs, to do the work for you. “You need to make sure that coders are using the codes the right way, not just mapping the codes,” Lott says. Highlight skill sets to solve concerns

When coding and CDI teams work together, they can optimize their practice by figuring out how ICD-10-CM/ PCS challenges will fit with certain skill sets, says Weygandt. If coders cannot code due to gaps in physician documentation, and if they need to query the physician retrospectively to resolve those gaps, several negative effects could occur— among them delays in discharged/not final billed cases, as well as additional declines in productivity due to the increase in retrospective queries, says Stanfill. “We need to be helping the physicians improve their

documentation, not simply increasing the number of queries they need to answer,” says founding ACDIS advisory board member Gloryanne Bryant, BS, RHIA, RHIT, CCS, CDIP, CCDS, AHIMA-approved ICD-10-CM/PCS trainer and HIM professional in Fremont, Calif. Other challenges will specifically relate to coding theory, such as inpatient infant circumcision, where despite clear documentation, ambiguity related to the application of ICD10 procedural coding principles could arise, says Weygandt. “So facilities will need to identify those concerns also.” Swedish Health Services in Seattle began reviewing records for ICD-10-CM documentation improvement opportunities in the final months of 2013, according to Jennifer Woodworth, RN, BSN, CCDS, director of CDI. “We really wanted to make sure that we had query templates ready for the common [CDI-related] concerns, and that we clarified what documentation coders already had at their fingertips,” Woodworth says. Just as coders are dual coding, CDI specialists need to start dual reviews, Stanfill says, examining the record not only for documentation improvement opportunities needed in ICD-9 but also in anticipation of those that will be needed for ICD-10-CM/PCS. As each team makes new discoveries, they will need to share the lessons they’ve learned.

An October 2013 report shows that coders from various facilities had an average ICD-10-CM coding accuracy rate of just 63%. Nearly 75% of respondents to a December 2013 ACDIS ICD-10 survey indicated that CDI specialists meet with coders regularly, and that most of those respondents—30%—meet monthly (read the report on p. 24). Bryant calls the 25% which do not meet with coding staff “disappointing” and hopes that the two teams will increase meetings and collaboration in light of the ICD-10-CM/ PCS challenge. “As you learn, you’ll update your queries, refocus, and adjust your processes,” Stanfill says. “CDI is a key solution to the ICD-10 transition and a critical enabler to challenges related to the implementation. The CDI song, in terms of ICD-10 implementation, is the same song the coders are learning, it’s just a different verse.”

For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, please contact the Copyright Clearance Center at www.copyright.com or 978-750-8400. © 2014 HCPro, a division of BLR.

January 2014

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