Health Information Management

Start your ICD-10-CM training by assessing your coders' preparedness

JustCoding News: Inpatient, August 18, 2010

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Aesop’s fable of the ant and the grasshopper teaches us the value of planning ahead. While the grasshopper sings the summer away, the ant is hard at work collecting food for the coming winter. When winter arrives, the ant eats from his reserve while the grasshopper dies of hunger.

The story is a bit morbid, but the moral is clear, “To work today is to eat tomorrow.”

Some HIM directors are applying that message and getting a jumpstart on planning for the switch to ICD-10-CM/PCS. Although the October 1, 2013 implementation date is still years away, they are already assessing their coding staff’s knowledge of core concepts so that training addresses any weaknesses.

Test your coders

Phelps Memorial Hospital Center (PMHC) in Sleepy Hollow, NY, has already begun its ICD-10-CM training process, according to Teresa Silversmith, RHIT, CCS, C-CDI, director of HIM at PMHC.

“I’m the type of person that believes you can never be too prepared,” says Silversmith. “Success has a lot to do with proper preparation.”

Silversmith is in the process of testing her coding staff on basic anatomy and physiology. She assigns quizzes that she finds in journals, websites, or newsletters, such as the anatomy quiz featured in the August issue of HCPro’s Medical Records Briefing newsletter.

Silversmith then reviews the results to help her determine the specific areas where her coders need more training so that they are prepared to code with ICD-10.

The idea of assessing coders’ ICD-10-CM/PCS preparedness is not exclusive to PMHC.

Christine Lewis, manager of health information services at Medical University of South Carolina (MUSC), and Donna Wilson, RHIA, CCS, senior director of Compliance Concepts, Inc., based in Wexford, PA, encouraged their colleagues to assess coders’ strengths and weaknesses during the annual South Carolina coding roundtable meeting.

During the meeting, Lewis told the group that all of MUSC’s hospital coders and physician coders will complete an online, multiple choice assessment test developed by an online training company. The test covers basic anatomy, physiology, pathology, and ICD-9-CM coding guidelines.

After the coders take the exam, which Lewis estimates will take one and a half hours to finish, they will complete related online learning courses that address areas where they demonstrated weaknesses. She also plans to schedule additional education to compliment MUSC’s monthly coder proficiency training sessions.

Create your own preparedness tests

Even though in this case Lewis outsourced the testing materials, facilities do not need to resort to hiring an online training company to evaluate their coders. Wilson created three assessment quizzes to test coders at her clients’ facilities using the American Health Information Management Association’s Certified Coding Specialist (CCS) Review Guide 2009 Edition.

The quizzes cover basic coding guidelines, conventions, and anatomy relative to three coding disciplines—inpatient, outpatient surgery, and diagnostic testing. Each quiz has 30 multiple choice questions, five short-answer questions, and five records to code.

Creating quizzes internally may be a helpful strategy for smaller facilities that cannot afford to contract with an online learning company and commit resources for more one-on-one training.

Analyze the results

After reviewing the results, Wilson noticed that many coders have forgotten basic coding conventions, such as the meaning of “excludes” notes. Note: The meaning of excludes notes will ultimately change in ICD-10. To learn more, access JustCoding’s ICD-10 Watch blog. She attributes this to the fact that coders are typically subject to tight time constraints and have become more encoder dependent. Because some coders no longer rely on coding books, they are susceptible to overlooking important notes in the manual as they try to quickly assign codes and move on to the next record.

Lewis agrees. Upon conducting internal reviews to prepare for recovery audit contractors, she has observed that many coders tend to focus on speed due to coder productivity demands, which can lead to errors.

“We have to get back to basics again and make sure coders realize when they see an excludes note or a Coding Clinic reference that they pull it up and read it,” Lewis says.

Although MUSC coders have not yet completed the assessment test, Lewis anticipates that because the group is so large, they will show weaknesses in all areas.

Silversmith says the level of anatomy proficiency PMHC coders will need to attain to assign ICD-10-PCS codes is more in-depth and will require additional coder training. She plans to schedule ongoing training to address weaknesses that the assessment test identifies. Also, PMHC’s lead coder will attend a ‘Train the Trainer” program so she can then take what she learns and help train her colleagues.

Start early and conduct ongoing assessments

Some HIM directors may skip the evaluation step and simply train their coding departments with an all-inclusive training program closer to the 2013 implementation date. However, Wilson feels that focused training will go a long way toward ensuring correct ICD-10 code assignment.

“Utilizing a common training program for the coding staff is less time consuming, but taking the time to find the strengths and weakness of your coding staff will be invaluable in reducing coding errors in the future,” Wilson says.

Lewis agrees. Getting an early start and periodically reevaluating coder proficiency in key areas also allows MUSC to assess the effectiveness of its training methods.

“Everyone has a different way of learning,” Lewis says. “We cannot rely only on online training. We are going to have to present the information in different ways, so people are on the same page.”

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

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