Health Information Management

Analyze ICD-10 implementation timeline and identify tasks for each year

JustCoding News: Inpatient, July 21, 2010

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If you’ve attended any audio conferences or trainings related to ICD-10, then you’ve probably heard from numerous experts that there simply isn’t a cookie cutter solution for ICD-10 planning and implementation.

But there are some universal steps that you should incorporate into your timeline for preparation and implementation of this new code set, said Margaret Skurka, MS, RHIA, CCS, FAHIMA, professor and director of HIM programs at Indiana University Northwest in Gary, IN, who presented in April a session titled “The Road to an ICD-10 Proficient Coding Staff” at the American Health Information Management Association’s ICD-10 Summit in Washington, DC.

Initiate physician involvement in 2010

Providers should already be working on getting physicians involved in the planning for ICD-10, particularly explaining to physicians by specialty the effect the new coding system will have on their practices.

Gauge training needs by conducting assessments of staff members (e.g., coders, admissions, precertification, and registration) to better determine their knowledge of ICD-10. Although it’s too early to train coders about the new codes, now is a good time to provide overview education about ICD-10-CM and ICD-10-PCS to help foster comfort with the transition and dispel any myths and misconceptions about the new coding system, Skurka said.

“If they become comfortable with what this is about, then you’ll get more cooperation,” she said. “Maybe conduct a two-hour seminar for coders and a one-hour for other staff members and cover basic examples of the new codes.”

Tackle documentation concerns and anatomy and physiology education

In 2011, intensify training efforts and provide more education about the fundamentals of ICD-10-CM and ICD-10-PCS (e.g., guidelines and code structure).

Also, it’s critical that providers work with physicians to improve documentation so that physicians learn to integrate the necessary terminology and details in their documentation, Skurka said. This will help coders to assign ICD-10 codes, which are much more specific and require significant additional detail than what physicians are currently used to documenting.

“For hospitals, much of what we see in the documentation may be there, but on the physician side for coders who are working off of a piece of paper, they may not have this kind of data,” Skurka said.

In terms of coder education, focus on anatomy and physiology. Build on efforts to strengthen knowledge about medical terminology, particularly for inpatient coders, who will need to have a solid understanding of the different approaches and root operations that are fundamental to ICD-10-PCS.

“Maybe one of your orthopods, for example, can give a little mini-series and encourage other physicians to help with anatomy and physiology education,” Skurka said.

Gear up education in 2012, and study ICD-10 guidelines

In 2012, it’s time to intensify coder training and have staff members examine the ICD-10 guidelines in more detail and practice assigning the codes. On the CMS website, you can access the ICD-10-CM Official Guidelines for Coding and Reporting for 2010 as well as the ICD-10-PCS Coding Guidelines.

Ensure that the organization continues to involve all physicians in education related to documentation improvement as well as anatomy and physiology.

Examine high-volume services and practice coding real records in 2013

The go-live date of October 1 will be fast approaching once 2013 hits. By this time, coders should be able to capture the necessary detail in documentation to assign ICD-10 codes. Coder training and practice should be detailed and involve real medical records and documentation so that you can identify any outstanding weaknesses.

Look at codes and types of records for which your staff most commonly assigns codes and determine how well and how fast your coders can assign codes for those cases, Skurka said. “Let’s see if it gets easier [with ICD-10],” she said. “Start with the more common conditions, and get that right, then work your way down to more unusual issues.”

For example, examine the top 25 services that your OB-GYNs perform, and determine the initial impact of ICD-10 in those areas.

Look at the estimated training time that your coders will need—approximately 16 hours for ICD-10-CM and as many as 50 hours for ICD-10-PCS, depending on the experience of the coder and whether the coder is inpatient or outpatient.

There may be terms that neither your coders nor your physicians are used to using. For example, consider the Gustilo classification of fractures. “I had never heard of this before,” Skurka said. “I asked my friend’s husband, who is an orthopedic surgeon, how often he had used the Gustilo classification, and he said, ‘Twice in 25 years.’”

This is a clear example of conversations that need to take place, not only with your coders, but also with your physicians, to make sure your organization has the best chance for a smooth transition in 2013.

Editor’s note: E-mail your questions to Managing Editor Doreen V. Bentley, CPC-A, at

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