Health Information Management

Consider dual coding in advance of ICD-10: Three facilities share their approaches

JustCoding News: Inpatient, February 15, 2012

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Most health information management (HIM) directors have October 2013 looming in their minds as the ICD-10 implementation deadline. But according to many experts, coders should be coding in both ICD-9 and ICD-10 well in advance of that date.

The reasons are many. Not only will dual coding help guide educational efforts and give coders plenty of practice, but it can provide hospitals with valuable data. It can also help identify trends in physician documentation shortcomings.

How best to set up a dual coding system in your hospital and when to do it, however, is more difficult to ascertain. The right tactic will depend on each facility's ICD-10 education plan, and may be affected by hospital systems and tools such as encoders or computer-assisted coding.

To give you a sampling of some different approaches, Medical Records Briefings (MRB) reached out to members of the "MRB Talk" listserv. We hope three of their stories will give you some good ideas on how to structure a program of your own.

Wheeling Hospital

Sheila Schultz, RHIT, director of medical records at Wheeling (WV) Hospital, plans to begin dual coding in October of this year.

She set the stage with an ICD-10 education program that began in January for her coders (two staff members attended the American Health Information Management Association's [AHIMA] training program in 2011). The coders have already been introduced to ICD-10 through audio conferences, including participating in anatomy and physiology (A&P) audio conferences. Schultz is adopting a conservative educational approach spread out over a long period of time. She thinks this will allow coders to retain information better than, for example, cramming everything into a single fast-paced and potentially overwhelming week.

"Also, you can't pull your coders out of work for a long time [all at once] because you'll get a backlog," Schultz says. In addition, the clinical documentation improvement (CDI) staff will be training with the coders throughout the year. (Staff members from other departments will likely receive their education via an online learning format.)

Then, beginning in October, each of the coders will begin to perform a little dual coding every day, even if their productivity goals only allow time for a single chart. "If time allows, they can do more—perhaps two or three inpatient charts and the ED coders would do maybe five ED charts," she says.

Schultz has been lucky to get additional budget dollars for coder overtime hours so the coders will have time for education and the dual coding practice. She doesn't think they could have managed otherwise.

"Realistically I don't see as we're currently staffed—and we're already bringing in new staff—that with the volume the coders have and with the volume of work coming toward us … with ICD-10, we would totally get bogged down just with outpatient diagnostics, without even looking at inpatient charts," she says.

Wheeling Hospital uses a 3M encoder that has the ability to show potential ICD-10 code selections after coders make their ICD-9 code selections. Come October, the hospital's abstracting system should also be set to accept ICD-10 codes. That way, they'll start collecting codes for abstracting, hopefully just to store the information for now, even though they won't be applied to bills yet. Data collected will also help the hospital see what financial effects it might experience when ICD-10 is implemented.

And even if the systems aren't ready for dual coding come October, Schultz plans to have her coders practice regardless.

"Trainers will audit the charts and feedback would then be given to coders for educational purposes," Schultz says.

St. Mary's Hospital

Coders at St. Mary's Hospital in Athens, GA, will begin coding in both ICD-9 and ICD-10 beginning in the second quarter of 2012, according to Sandra Berryman, RHIA, MBA, CHP, director of health information services at the hospital.

Dual coding is part of St. Mary's overall education and implementation plans. "The coders have been part of putting together the plan so as to have a seamless October 1, 2013, transition—we like to dream," Berryman says.

Education began in 2011 in the form of audio conferences, including those on A&P with a focus on ICD-10. In addition, two of St. Mary's six coders attended AHIMA's Train the Trainer program. Beginning in 2012, the coders will meet for one and a half to two hours every other week to jointly code and discuss the coding of four to eight cases. This will give everyone an opportunity to talk through and get comfortable with the processes. In addition, a weekly e-mail "quiz question" will be sent out to physicians' offices and other hospital staff, with prizes for correct responses.

"All of the training will also include our two CDI specialists—one [who is] an RN and the other a CCS—as they are an integral part of our coding team," Berryman adds.

The coders felt that double coding could wait until the first quarter of 2013 with 25% of their charts. By the third quarter, they anticipate coding 50% of the charts in both ICD-9 and ICD-10.

St. Mary's will also be contracting with a third party to conduct audits in order to establish a baseline of coder ICD-10 competency at the beginning of 2013 and then again in the third quarter of 2013.

The hospital, which has contracted with a vendor to handle its overflow coding, expects productivity to decrease as dual coding ramps up.

"[The vendor] understands that, while we don't currently have a need for outside coding, our need will increase over time as our volume of double coding gets higher, with lots of business for them after October 1, 2013," Berryman says. "We currently send them a small weekly or biweekly number to code just to stay familiar with our systems, physicians, and processes."

Coder education will be ongoing based on the results of the ICD-10 coding, and other staff members will be brought up to speed as well. St. Mary's is currently looking at conducting on-site education for anyone who deals with codes directly or indirectly, and offering focused training for its physicians, part of which may be in video-based format.

Driscoll Children's Hospital

Rachel Reyes, RHIA, HIM director at Driscoll Children's Hospital in Corpus Christi, TX, anticipates that her facility will begin dual coding in April 2013. At that point, she expects to randomly select records from various patient types, with an emphasis on med-surg records.

Reyes says the coders will all code the same records so she can compare the results. "I would compare this process to one we use when screening coding applicants. It allows us to assess a coder's skill level," she says.
The coders at Driscoll Children's Hospital have already begun learning ICD-10, though not yet in great detail. Intense training will begin six months prior to October 2013. All coders are expected to be certified by May 1, 2012, and their coding compliance manager is an AHIMA ICD-10-CM/PCS trainer.

Pending budgetary approval, Reyes plans to budget for two or three contract coders, who would work from one month prior to October 2013 until approximately six months after the implementation date. Starting a few weeks before the final deadline will allow them time to become familiar with Driscoll's records.

Also in the works is a new CDI program, which the hospital plans to implement by April 2012. "Through the CDI program we will identify documentation issues and, hopefully, prepare our doctors for what we need for ICD-9 as well as ICD-10," Reyes says. The data the coders collect through dual coding will also enhance their CDI efforts.

Editor’s note: This article was originally published in the March issue of Medical Records Briefing. E-mail your questions to Senior Managing Editor Andrea Kraynak, CPC, at

To learn about managing the transition to ICD-10-CM/PCS codes, sign up to participate in The JustCoding Virtual Summit: ICD-10-CM and ICD-10-PCS, which will take place February 29–March 2. During this three-day event, you will have the opportunity to hear from an array of experts, who will share guidance for the challenges of ICD-10 preparation and implementation. You will also be able to network with your peers and participate in question and answer sessions—all without ever having to leave your office.

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