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By Mike Evans, RHIA, CCS, vice president of coding and compliance at In Record Time, Inc.

Now that ICD-10 has been delayed until October 1, 2015, many organizations are left wondering how to make the most of this interim time. Our experience has been that as many as 50%-60% of hospitals slowed their ICD-10 efforts when the delay was announced. Although many organizations have chosen to put ICD-10 on a back burner for now, this isn’t necessarily the best solution, nor will it yield the most effective long-term results. Instead, HIM professionals—with the support of executive leadership—should devote as much time as possible to auditing, documentation improvement, and physician engagement.

 Consider the following strategies:

1.      Be transparent with physicians. Any major change can be scary and overwhelming, and the transition from ICD-9 to ICD-10 is no different. Even though they may not admit it, physicians could be among the most anxious about the new coding system because they know that their documentation will affect code assignment directly. Physicians may feel as though there simply aren’t enough minutes in the day to document some of the details required by ICD-10. To complicate matters, physicians face many other administrative challenges as well, such as Meaningful Use and quality reporting, both of which can affect their bottom line. Many of today’s physicians feel overburdened by a healthcare system in which third-party audits continue to mount, and additional regulatory requirements seem to grow annually.


The American Medical Association and various subspecialty organizations have voiced considerable opposition to ICD-10. Many physicians feel as though ICD-10 is being forced upon them rather than integrated into their daily workflow based upon their own input. This could be because many physicians weren’t involved in ICD-10 since the very beginning of its clinical modification for the United States. Although HIM professionals can’t rewrite history, they can talk openly with physicians, address their concerns, and most importantly, acknowledge their frustrations. Consider these tips:

·         Keep physicians in the loop. Send regular communications to medical staff about ICD-10 developments and news. Physicians will appreciate the outreach.

·         Focus on severity of illness (SOI). SOI has become incredibly important in terms of outcomes and data reporting. Every physician must understand how his or her documentation affects SOI scores because eventually, this information may affect one’s ability to participate with hospitals and insurers that will only want to contract with those who have the best quality outcomes. As Accountable Care Organizations continue to grow, only the best and brightest physicians will likely survive and thrive.

·         Listen. Simply listening to a physician voice his or her frustration about documentation requirements may go a long way in terms of changing his or her behavior. Let physicians know that the HIM department is available to answer questions and serve as a resource for physicians.


2.      Ensure time for dual coding. Although it may be difficult to justify dual coding indefinitely, coders need hands-on practice with ICD-10. This critical practice time coding records in both ICD-9 and ICD-10 allows coders to identify documentation gaps and educate physicians accordingly. Working with an outsource coding vendor can help create time for internal staff to dual code without interrupting cash flow. Start with high volume and/or high cost diagnoses and procedures to maximize efficiency.


3.      Identify a physician champion. HIM professionals know that it can be difficult at best to change physician behavior. If organizations haven’t already identified a physician champion, they should take the time provided by the delay to do so now. Consider these tips:

·         Choose an individual who is well-respected and an excellent communicator.

·         Look for someone who has excellent EHR skills and whose documentation can set an example for others.

·         If possible, identify one physician champion for medical cases and another for surgical cases. This avoids overburdening one individual, and it also helps send a message to the entire medical staff that the organization values their input enough to devote multiple resources to the effort.

4.      Work with your outsource vendor to identify additional strategies. Organizations that outsource all or a portion of their coding to a vendor should work closely with that vendor to identify opportunities for documentation improvement. A reputable vendor should perform ongoing quality reviews and audits and be willing to share that information with the organization.

ICD-10 delay causes challenges for HIM professionals:

Moving forward during uncertain times

 By Mike Evans, RHIA, CCS, vice president of coding and compliance at In Record Time, Inc.

When the ICD-10 delay was announced in April, most HIM professionals cringed at the thought of having to spend yet another year in limbo preparing for the transition. Working with an extended timeline has posed variety of challenges that physicians, legislators, and others in favor of a delay had not likely considered. Following are some of the most striking ones that affect HIM professionals directly.

Expensive coder refresher training. Many organizations had begun to provide coder training in anticipation of the original October 1, 2013 deadline and subsequent October 1, 2014 deadlines. Not only must these organizations now provide ongoing refresher training, but they’ll also need to consider careful strategies to retain coders in whom they’ve invested significant training dollars. Personnel changes complicate matters. As coders come and go (e.g., as coders find new jobs elsewhere, take time off, or retire), it becomes more difficult to maintain a secure set of knowledge.

Increased overall costs. In 2012, CMS estimated that a one-year delay could cost the industry as much as $6.6 billion. This statistic was reiterated in a letter from the Coalition for ICD-10—a constituency of organizations across the healthcare spectrum—to CMS dated April 11, 2014. According to a February 2012 Edifecs survey of industry reaction to the potential delay of ICD-10, 49% of respondents estimated that every year of delay would increase their required budget by 11%-25%. Thirty-seven percent estimated an increase of 26%-50%. Increased costs can largely be attributed to the need for ongoing training as well as outsource coding assistance so internal coders can gain hands-on experience with ICD-10. The longer the industry works with both ICD-9 and ICD-10, the greater the impact on overall productivity and cost.

The need to regain executive buy-in. HIM professionals may unfortunately bear the brunt of CFO frustration with ongoing ICD-10 costs. When the most recent delay was announced, many CFOs made the decision to drastically reduce ICD-10 budgets or even cut them entirely. Now, HIM professionals must restart facility-wide momentum even in the midst of ongoing skepticism. HIM professionals must re-engage executive leaders and medical staff in the ICD-10 effort. This will not be an easy task during a time when initiatives such as Meaningful Use, EHR implementation, hospital acquisitions and mergers, and a variety of other changes are vying for physician attention and hospital resources.

The need to re-engage physicians. It was difficult to engage physicians before the delay was announced. Now, it’s even more difficult to convince them that ICD-10 will, in fact, go live on October 1, 2015. Engaging physicians is an expensive and time-consuming effort that often requires the identification of physician champions, detailed documentation auditing, and personalized physician education sessions. Many physicians may be particularly resistant to learning the nuances of ICD-10 because they are unconvinced of its importance. This creates ongoing challenges for HIM professionals who must find creative ways to obtain physician buy-in.

Fear of the unknown. Experts agree that coder productivity could decline as much as 50% in ICD-10. The specific decrease will depend on a coder’s experience and education as well as system integration. Coders have been coding with this fear for several years. Some coders have even retired out of fear. Managing workers in an environment in which uncertainty and fear remain high has been—and will continue to be—challenging.

 As organizations continue to uncover challenges resulting from the ICD-10 delay, it’s important to consider these tips:

 ·         Provide ongoing refresher training for coders. This should include training in anatomy, physiology, pathophysiology, and ICD-10 guidelines. Allow coders to dual code regularly as well as attend state and local coding chapter meetings where they can receive cost-effective training. Also explore other free and low-cost training options.

·         Talk openly with coders so you can understand their short- and long-term employment plans.

·         Open the lines of communication between HIM and the C-suite. Set realistic expectations for budgeting that will allow for flexibility while also ensuring enough dollars for ongoing training.

·         Re-examine coder responsibilities. As the industry moves closer to ICD-10, coders must focus specifically on coding. If their duties also include abstracting or release of information, for example, consider reassigning those responsibilities to other staff members. This will help mitigate productivity loss and give coders more time to practice ICD-10.

·         Identify physician champions who can assist with physician re-engagement.

·         Consider outsourcing some or all of your coding. Maintaining an internal coding department may not be a cost effective solution at the present time.

Absolutely NOT!! First and foremost, no one has implied that all areas of training have to be extensive and expensive. What must be all-encompassing, however, is the evaluation of skill level in these areas. First, determine the level of standardized skill required (such as 90th - 95th percentile success) in a pre-designed set of assessments; this way, the coder would only need to remediate areas where his/her proficiency may be lacking. Those skills that the coder currently maintains at a high level would need no further repetition. One critical link is recognizing that the coders are adult learners and the material must be designed (either for skill evaluation or training) with adult needs in mind while recognizing that most coders work at minimum a 40 hours/week and have obligations outside work.

Our profession was very fortunate when a group of health information administrators and technicians were selected from inception in the design and development of ICD-10-CM and PCS. Their trials and tribulations along their journey paved the way for our successes. As a profession, we strive for data quality being job#1, and nationwide standardized diagnosis and procedure coding can only be accomplished if all coders have similar skill sets. When taking this into consideration, we must recognize that many of our current coders have been out of mainstream education for greater than 5-15 years and have focused their educational efforts around yearly continuing education units for an outdated ICD-9-CM classification system.

Take a look at each of the two new ICD-10 coding classification systems. Both are so advanced and so exact in their code design and definition that we will have more clarity to become more standardized. This, however, can only be accomplished by understanding the medical sciences surrounding each of the ICD-10 coding systems and being able to apply this knowledge into the correct coding structures and functions as defined by our medical documentation.

In the next blog, we will discuss coder training needs for the two coding and classification systems. Remember, we are not to far away for the ICD-10-CM and PCS go-live date of October 1, 2014.

What can In Record Time do for you now, individually or for your organization, to ease the stress associated with your ICD-10 preparation? We can provide you with an ICD-10 training solution and/or the remote coding support that you need during this time! Contact us today!

A needs assessment must be developed very early on in the process of developing the ICD-10 program.  Because so many players inside and outside of HIM/Coding will be affected by the need for these new codes, a department-wide and individually-specific needs assessment must be developed.  This assessment will give the individual an opportunity to perform a self-assessment of his current education and subsequent skills in anatomy, physiology, medical terminology, and coding along with specific needs for any ICD-10 data.  The departmental needs assessment will give the department director an opportunity to assess the needs of their department’s data needs prior to implementation.  Collection and correlation of data is key in determining how the hospital moves forward in their planning stage.

Contact us today to find out how In Record Time can assist your HIM Department with preparation for ICD-10 CM and PCS!

The first step in preparing for hospital-wide training for ICD-10-CM/PCS is the development of a comprehensive hospital-physician-coder management Committee.  The Committee’s purpose is to define its implementation objectives, set time tables to meet objectives, and to serve as the administrative umbrella for all ICD-10-CM/PCS management related issues.  Members of this Committee should include key medical staff, hospital administration, information technology, nursing, quality assessment, HIM, coding, case management, and patient access to name a few.

Contact us today to find out how In Record Time can assist your HIM Department with preparation for ICD-10 CM and PCS!

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