ICD-10: Cedars Sinai's 4 tips for success

Once the new code set has rolled out, the work has only just begun.
By Bernie Monegain
05:14 AM
Cedars Sinai Medical Center

They may be in the Big Easy, where the good times roll, but the people in charge of managing health data at hospitals across the country are focused on the hard work of realizing the most benefit they can from ICD-10.  

Ongoing education and assessment are critical to success for healthcare systems transitioning to the new code set, according to early adopters at the American Health Information Management Association's 87th Annual Convention and Exhibit this week.

"CMS has set October 1 as the deadline for compliance with ICD-10, but our experience has taught us that initial implementation is just the start of a successful transition to the new code set," Thea Campbell, director of health information at Cedars-Sinai Medical Center in Los Angeles, said in a press statement.

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Cedars-Sinai, one of the nation's earliest adopters of ICD-10, began dual coding with both ICD-9 and ICD-10 in October 2013.

As Campbell sees it, healthcare providers may experience decreases in productivity in the early days of implementation and should be prepared to commit resources to education and assessment tools as the program rolls out. 

[See also: ICD-10 readiness: shaky optimism.]

"In the months leading up to the deadline for implementation there was a great sense of urgency about ICD-10, and CEOs and other top managers were committed to providing whatever resources were necessary to prepare coders and others to transition to the new system," Campbell added. "As health information professionals, we must continue to convey that sense of urgency as we evaluate our systems, identify challenges and risks, and design proactive initiatives to address them."

Campbell offered four key recommendations based on the Cedars-Sinai experience with its ICD-10 conversion.

  1. Provide ongoing education and re-education for coders. ICD-10 has 68,000 diagnostic codes compared with 13,000 for ICD-9. Even coders with decades of experience are in many ways 'beginners' with ICD-10. Initial training will give them the knowledge to start coding in ICD-10, but only hands-on experience and educational feedback will give them the expertise to reach pre-implementation levels of productivity and accuracy."
  2. Conduct proactive coding audits and assessments. Don't wait until you start to get coding denials before you audit your coders. It's important to proactively identify errors and take steps to correct them as they occur.
  3. Increase hiring of inexperienced coders. Traditionally, we've been hesitant to hire coders who have completed their education but have no previous experience. Take advantage of the training programs already in place for ICD-10 to recruit coders without real world experience, train them and move them along a career ladder that will build loyalty and reduce turnover.
  4. Evaluate procedures for professional fee coding. With ICD-9, physicians and other professionals at Cedars-Sinai were responsible for entering the diagnostic codes for the services they rendered. We are looking at the commitment required of physicians to learn the new ICD-10 coding system to decide whether that's the best use of their resources. First and foremost, we want our physicians to be focused on providing patient care. The medical center is exploring the possibility of using coders to do pro-fee coding and training physicians and other professionals in how best to document patient care so as to facilitate accurate coding.

Thomas Ormondroyd, vice president and general manager, Precyse Learning Solutions, joined Campbell to present the AHIMA convention session on Monday.

They detailed the step-by-step approach taken by Cedars-Sinai in the years leading up to implementation, and discussed challenges and risks in inpatient coding, outpatient coding, clinical documentation and other revenue cycle issues encountered in the implementation process.

See also:

ICD-10: 3 tips for keeping coders productive 

CMS says government shutdown won't stop ICD-10 

ICD-10 go-live: NIghtmare or non-event?


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