Health Information Management

Q&A: Staffing preparation for ICD-10

CDI Strategies, March 28, 2013

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Q: How are staffing needs expected to change in relationship to ICD-10?

A: I’m not aware of any benchmarks for CDI staffing in consideration for ICD-10.  There is so much diversity among CDI departments and their responsibilities regarding ICD-10 that it is hard to establish any guidelines. 
 
However, I can tell you that in my opinion, most CDI departments are understaffed and this will just be exacerbated by ICD-10 implementation. The biggest issue to consider, prior to thinking about staffing, is who will be responsible for what types of queries, query follow-up after discharge, and provider education.
 
If the coding department currently issues queries, it is unlikely they will be able to sustain that query function considering the expected decreased productivity associated with ICD-10 implementation. That means all query efforts—concurrent and retrospective—will likely default to the CDI staff.  In other words, CDI staff may be querying for specificity for code assignment in instances where there is no financial, quality metric or mortality metric gain because coders will be unavailable to do so.  Most CDI staff do not query so broadly under ICD-9. 
 
Furthermore, the CDI team needs to consider the additional query volume related to concurrent queries due to ICD-10 coding requirements. Many elements of ICD-10-CM Official Guidelines for Coding and Reporting, such as combination codes which require documentation of a cause and effect relationship, will likely increase the volume of queries. 
 
Additionally, organizations need a plan to address procedure coding (PCS) as every PCS code has seven characters, each relating to documentation in the record. Traditionally, CDI staff have not queried for procedures except for excisional debridement clarification. CDI departments may need to hire nurses with surgical experience to assist with PCS coding/querying. 
 
Querying and provider education are the most labor intensive responsibilities so it is unlikely that any organization is adequately staffed to meet these impending demands. To my knowledge, most consultants conducting ICD-10 readiness assessments are recommending additional CDI staff – how many depends on current staffing volumes and the expected role of CDI. 
 
Editor’s Note: Cheryl Ericson, MS, RN, CCDS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, CDI Education Director for HCPro Inc., answered this question which was originally published on the ACDIS Blog. Contact her at cericson@hcpro.com. For information regarding CDI Boot Camps offered by HCPro visit www.hcprobootcamps.com/courses/10040/overview.



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