Education on ICD-10 coding guidelines and conventions will give you the facts and rules of this new transaction coding classification but processing the knowledge, using mental and physical sweat equity, and self- motivation skills enable you to appreciate the value of this knowledge. To elaborate further, you must know how to research, collect information, and ask questions in order to process knowledge. We’re not dealing with osmosis here, you will have to apply yourself and be open to a new way of doing things. Remember, if it’s easy, it’s wrong! Lack of motivation is lack of knowledge processing skills.
Any teacher will tell you how important lesson plans are to describe the course of instruction for each individual lesson, each skill level involved. Well-developed lesson plans reflect the interests and needs of the students. They should incorporate best practices by specialty or specific coding needs. Some key things to remember when developing educational programs:
- Outline the subject title of the lesson and do not schedule lengthy classes; it will take time to absorb the material and time to comprehend the lesson.
- Make sure you have necessary materials ahead of time: books, pads and paper, etc.
- List your objectives, which may be what the student can do at lesson completion or, knowledge objectives, what the student knows at lesson completion.
- Include “hands-on” exercises after each concept learned and finally, a test for mastery of the instructed skills or concepts—such as a set of questions to answer or a set of instructions to follow.
- Monitor the student’s progress with review classes as October 1, 2013 approaches. This can be a time of questions and answers or discussions based on previous practice exercises or clinical inquiries.
The accuracy of ICD-10 diagnosis coding will directly impact revenue flow. Each returned claim for lack of medical necessity or an invalid code increases use of resources and delays payment. Compliance starts with the first step towards ICD-10 implementation. Introduce ICD-10 volume 1 and 2. Review the alphabetical index and specified tables, (Neoplasm and Table of drugs and chemicals), followed by external cause index. Note the similarities and differences between ICD-9 and ICD-10 rules. The official Coding Guidelines for ICD-10-CM can be found on the web: http://www.cdc.gov/nchs/data/icd9/10cmguidelines2011_FINAL.pdf.
Start training early for key individual(s) who will be most closely involved with the implementation and conversions. Clinical and coder workload will increase since coders are now looking for more information in the patient record documented by the physician. Education for the physicians and clinical staff must drill the fact that if it isn’t documented, it can’t be coded. Documentation may include laterality, status of fracture healing, status of encounter (initial, subsequent, sequel), or fetus affecting care and management of mother. Focus on the differences, such as numeric vs. alphabetic characters, and logic changes due to the revised structure of the codes in ICD-10.
Do not underestimate the time that will be required to train medical and office staff. More, in this case, is better. As with ICD-9-CM, ICD-10-CM/PCS codes should be based on medical record documentation. While documentation supporting accurate and specific codes will result in higher-quality data, nonspecific codes are still available for use when documentation doesn’t support a higher level of specificity. All documentation practices should be examined to determine if the level of detail and specificity is available to support ICD-10 codes. If deficiencies are found, they should be recorded and included in the educational curriculum.
Design your education specific to user groups to include administrative staff and clinical staff, including physicians and other clinicians who document on the health record. The focus of education will be dependent on staff type.
The following topics should be included in coder and clinician training classes:
- Introduction and brief history
- Format and structure
- Placeholder character
- 7th characters (Chapters: 13, 15, 18, 19, 20)
- Includes 1 note
- Includes 2 note
- Etiology/manifestation convention
- Multiple coding
- Late effects (sequela)
- Laterality
- Chapter 20 (External causes)
- Chapter 21 (ICD-9 “V” codes)
- Chapter 19 (Injuries and poisoning)
- Chapter-specific guidelines
- “Blocks” of related conditions
- Upgrade of superbills or drop menu’s
- Detail in physician documentation
- “Use additional code”
- Practice scenario’s related to specialty
2013 is coming; will you be ready? This is the year of learning a new language. The learning curve will be January through September and on October 1, 2013, we will all be speaking the same language when assigning ICD-10 diagnosis and PCS codes.
Nancy Maguire, ACS, PCS, FCS, HCS-D, CRT, author of The Nancy Maguire GPS to ICD-10-CM Planning and Implementation Guide, is a nationally-renowned procedural and diagnostic coding instructor, bootcamp trainer, and workshop leader. She has spent more than 30 years as a hands-on coder and has authored countless coding articles and presentations. In her expansive career, she has transitioned from nursing, to coding, to practice management, auditing and consulting. Nancy served as Director of Coding and Reimbursement at UTMB in Galveston Texas for four years. She served the first two terms as president of AAPC in the early 1990s.
Hear Nancy speak in two complimentary archived webinars on ICD-10 presented by Kareo medical billing software: How to Prepare for ICD-10/5010 to Reduce F41.1 (Anxiety Reaction) or Preparing for ICD-10-CM: The Nitty-Gritty of Diagnosis Coding.
