HIMagine That! Here’s a Quandary – When Should We Start Coding in ICD-10?

March 27th, 2013 / By Sue Belley, RHIA, Donna Smith, RHIA

Sue:  I was at a state HIM meeting a few weeks ago and the question of when to start coding in ICD-10 came up.

Donna:  So, other than October 1, 2014, what was the consensus?

Sue:  Well actually, hardly anybody spoke up on this topic. One hospital representative said they were going to start coding in ICD-10 in September, 2013, and continue that forward through the ICD-10 go-live the following year. Oh, and someone from another hospital said they were going to have their staff start coding one inpatient chart a day or four-to-five outpatient charts a day. That hospital has only given the coding staff some introduction to ICD-10 but no real formal ICD-10 training. They just want their staff to start trying to code in ICD-10 anyway because they believe it might make ICD-10 a little less scary for the coders. Other than that, there was very little dialogue about when to start coding in ICD-10.

Donna:  That’s interesting. Why do you think that was?

Sue:  Probably because it’s overwhelming to think about actually operationalizing something like this! I mean, you to have to think about getting your coding and CDI staffs trained in ICD-10 first. Then the physicians need to be trained in ICD-10 documentation. Meanwhile, you still have to maintain your ICD-9 coding processes—coding productivity, the A/R—it’s difficult to insert ICD-10 into that equation! What’s a coding manager to do?

Donna:  I think the first thing a coding manager needs to do is determine the benefits of coding in advance for their organization.

Sue:  Such as . . . ?

Donna:  Well, for example, it will help get the coding and CDI staffs used to working with ICD-10 before it actually “counts”. It could be gradually phased in to help control for the impact to productivity. And it will help surface areas of documentation that need to be improved from an ICD-10 perspective, which will give hospitals time to work on getting these areas fixed. Documentation issues might include collection of information on EHR templates or education of physicians to improve documentation specificity.

Sue:  I agree with you—simulating the ICD-10 environment would definitely be beneficial!  Would the coders actually be dual coding then?

Donna:  Not necessarily. Dual coding means that the coder is coding both ICD-10 and ICD-9 codes simultaneously. In order to do this, their encoder needs to be technically able to support this. Another option is double coding, which means the record is coded once in ICD-9 and then again in ICD-10.  Their abstracting system would need to be able to capture the two code sets for either option.

Sue:  Got it. Even if their grouper cannot support both ICD-9 and ICD-10 right away, or their system is not able to capture the two code sets, coding in both ICD-9 and ICD-10 can be done. Come to think of it, that one hospital representative said they were going to have their coders capture the ICD-10 codes on paper until they could get their system ready.

Donna:  Hey, where there’s a will, there’s a way!

Sue Belley is a Project Manager with the Consulting Services business of 3M Health Information Systems.

Donna Smith is a Project Manager and Senior Consultant with the Consulting Services business of 3M Health Information Systems.