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TOPIC: Train your staff on the 2004 ICD-9-CM codes

HIM Connection, July 16, 2003

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TOPIC: Train your staff on the 2004 ICD-9-CM codes

Implementing the correct use of the new ICD-9-CM codes by October 1 requires education, awareness, and review of your forms facility-wide. This should be an annual process at all facilities, says Gloryanne Bryant, BS, RHIT, CCS, director of coding and HIM compliance for Catholic Healthcare West (CHW). To spread the word at the hospitals that comprise CHW, Bryant takes the following steps:

--Training coders

The six managers of CHW's corporate coding compliance department read the Coordination & Maintenance Committee minutes on the new codes so they can understand their development. "We also obtain information on what the codes represent clinically," Bryant says. What is the disease process or condition? How is it treated? Surgery? Medication?

Bryant's team puts that information into a PowerPoint presentation and conducts an all-day inservice on the code changes for the system's coding staff at 38 acute care facilities. They cover the rationale for the new codes, treatment modifications, and case scenarios.

--Training physicians Bryant and her team determine which new codes might be problematic for physicians' documentation.

Bryant puts together flyers on a particular code set or group of codes. A single-page flyer lists the codes, provides the descriptions, and explains how physicians should document for their use. In some cases, it may be appropriate to develop separate handouts for physicians in different departments or specialties. For example, it would be helpful to share the new prostate codes with physicians who perform surgery on the prostate so that they know the new descriptions can be captured. In addition, you may want to create a handout for the OB/GYNs on the new peripartum cardiomyopathy codes.

Because some codes will be used more often in an outpatient setting, Bryant and her team provide separate education to the emergency department (ED) staff. For example, the new codes for signs and symptoms are most applicable to ED physicians, since they're the most likely to encounter patients who don't have definitive conditions. The ED staff are also most likely to need to know about the new codes for concussions with loss of consciousness.

Bryant also suggests publishing the highlights of the new coding information in the medical staff newsletter.

--Training other staff Bryant's team also gives an inservice for the hospital case management staff. Because case managers closely monitor diagnosis, DRGs, and the relationship between the two, Bryant wants to make sure they are aware of changes. "We instruct them how to ask the physicians about a more specific condition," she says. Physicians appreciate that clinician-to-clinician relationship. "That's why it's important to educate outside of HIM," she says.

--Reviewing forms New codes may affect your query forms. In some years, the new codes lead to changes in wording and in others they lead to the necessity for a new query form. A new code often requires greater specificity and clarification in the documentation. Updating your query forms can also help enhance awareness for physicians, Bryant says. If you work with any physician practices, make sure you update encounter forms or fee tickets.

This week's HIM Connection was adapted from an excerpt of, "Educating the Staff on the 2004 ICD-9-CM Codes," part of the 2004 ICD-9-CM Training Kit. Go to for more information or to order your ICD-9-CM training package for just $99.

Sincerely,

Lauren McLeod
Executive Editor
lmcleod@hcpro.com

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