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  ICD10 Watch
by Carl Natale

Dual coding: Why you should be assigning ICD-10 codes ASAP

ICD-10 training seems to be an exercise in optimal timing. Medical coders shouldn't learn ICD-10-CM/PCS coding too early or they will forget what the codes mean by Oct. 1, 2014.

But Kristi Stanton makes the case that this is a good time to get into medical coding and learn ICD-10-CM/PCS. She's talking to untrained prospects who are looking for an educational program to give them the training needed to get jobs as medical coders.

If they follow her advice, will they be able to use their ICD-10 training? Maybe.

At least that's the recommendation I got from listening to 3M Health Information Systems experts speaking in a live Q&A on the ICD-10 final rule Sept. 5. JaeLynn Williams, senior vice president of marketing and client operations, moderated the panel:

  • Rich Averill, senior vice president of clinical and economic research
  • Sue Belley, ICD-10 education project manager
  • Rhonda Butler, ICD-10 clinical research analyst
  • Terri McCubbin, 3M consulting services
  • Donna Smith, senior 3M consultant

During the session, Belley recommended that training start immediately. It can improve coder confidence - which can encourage medical coders to stay in the profession instead of retiring to avoid using ICD-10 codes.

And there can be an opportunity to use the ICD-10 coding training if a medical practice or hospital has dual coding. This means coding medical records in ICD-9 and ICD-10 codes.

By coding constantly with ICD-10 codes, medical coders will keep their knowledge fresh.

It's also chance to calculate DRGs using both code sets, according to Smith. She said dual coding will allow healthcare providers to compare data and make sure that reimbursements won't change Oct. 1, 2014.

Dual coding also can help identify opportunities for clinical documentation improvement (CDI) and areas where physicians need training.

"You can start working with them," said Belley. It can start with asking simple questions. This will help them get used to being more specific and answering queries. Then the required specificity will not be a big adjustment Oct. 1, 2014.

But there will be costs. Systems need to be designed for dual coding. And no matter what your vendor promises, dual coding is extra work. That means there will be a productivity loss. Maybe computer assisted coding (CAC) will help.

It's very likely that you will need to assign extra coding resources. That means planning and budgeting for it, according to Smith. She recommends estimating the productivity loss and budget accordingly.

For example, let's guess that dual coding will mean a 20 percent drop in productivity. If your medical coders process 10 medical claims per day, then they will only be able to process eight under dual coding. To keep the number of claims consistent (and preserve cash flow), schedule staff to process those two lost claims.

Yes, that means payroll goes up. But it also lessens the chances of disruption in two years. If it's worth the investment is up to you.


While most coding systems

While most coding systems will need one or more updates to accomodate dual coding in ICD-10, there are options out there outside of a facilities standard coding system.
Consider re-coding claims at risk for shift, or your more complex claims as well as your highest quantity and reimbursable DRG's.
The only issue at this point in time is the available grouping software. Currently, the only one that I know of is the Version 28 MS-DRG grouper. While it works great, it is limited as it does not recognize any ICD's that were effective as of FY 2012 and beyond.
If anyone knows of an updated grouper for both ICD-9 and ICD-10, I would love to hear more about it.

You are right that payers are

You are right that payers are not receiving ICD-10 codes today. They can't b/c there are 5010 HIPAA edits that prevent ICD-10 codes from entering systems until the 10/1/14 compliance date. However, there are payers that are working w/some of their providers (primarily large hospitals and provider systems that provide are their top volume/revenue providers) receiving ICD-10 coded claims in a TEST environment for the purposes of understanding DRG shift and potential revenue impacts. However, this being done manually at the payer since systems including ICD-10 impacted configuration hasn't yet been remediated and definitely has not been fully tested.
If you are working in a provider setting and want to start testing w/some of your key payers, contact them to find out if this is possible and at what point they will be ready for this type of external testing.

How can using ICD10 now even

How can using ICD10 now even work? I don't know of s single payer who will accept the codes. Entering codes into a productions system is likely to cause more issues than resolve. At least this far out.

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