Health Information Management

News: Dual coding/CDI highlights holes in ICD-10 education, documentation, and program efficiencies

CDI Strategies, August 14, 2014

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Have you started dual coding for ICD-9 and ICD-10? Two facilities shared their experiences during a July AHA webinar. The first task is to determine what dual coding means for your facility, said Nelly Leon-Chisen, RHIA, director of coding and classification for the AHA. Are you coding records concurrently in ICD-9 and ICD-10, or are you coding in ICD-9 and then going back and coding in ICD-10? Figure out which approach will work best at your facility.


Also, are you coding natively in ICD-9 and ICD-10 or are you using some type of crosswalk? Again, that’s up to each facility to decide. One caution about crosswalks, though. You can’t code from a crosswalk alone. That’s not their purpose. A crosswalk can get you to the correct area of the codebook, but it won’t give you the precise code in most cases. Most ICD-9 codes map to multiple ICD-10 codes because the ICD-10 codes are more specific. If every code had a one-to-one match, we wouldn’t need to move to ICD-10.

A third point to consider: Is one person coding the same record in ICD-9 and ICD-10 or is one coding it in ICD-9 and someone else coding it in ICD-10? Cindy Hutchinson, CCS, CCS?P, corporate director of coding services for Intermountain Healthcare in Utah, shared that her coders are coding the same record in both systems. Initially, different coders were coding the record in ICD-9 and ICD-10; once the same coders started coding the records in both systems, it made them more efficient, she said.

Nine months into dual coding, most coders are back to their baseline productivity, with the exceptions of complex surgical cases and Intermountain’s children’s hospital.

Linda M. DiGregorio, RHIA, CCS, associate director clinical documentation, coding, and reimbursement for Winthrop University Hospital in New York, said her coders began dual coding with obstetrics cases in January. In February, they added concurrent dual coding of all hip and knee replacement surgeries, in addition to open reduction internal fixation cases. This month, they also began concurrently dual coding cardiac cases.

DiGregorio said coding productivity has dropped 60%.

Editor’s Note: This article originally published on the ICD-10 Trainer Blog.  Join Kathryn DeVault, MSL, RHIA, CCS, CCS-P, FAHIMA; Rebecca “Ali” Williams, RN, MSN, CCDS; and Tara L. Bell, RN, MSN, CCM, on September 10, 1 p.m., Eastern, for the webinar “Dual Coding/CDI: Practical Steps to Advance your Facility’s ICD-10-CM/PCS Readiness.”


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