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Education, Practice, and Analytics: The ICD-10 Trifecta
By Kim Felix, RHIA, CCS

With the race to meet the ICD-10 deadline, many HIM leaders are seeking resources to successfully usher their organizations into the new era of care. To ensure a strong ICD-10 transition, leaders will need to engage coder education and training programs that not only offer interactive, hands-on experiences but also support the right tools, allowing organizations to run valuable analytics to track and measure accuracy and productivity.

By incorporating education, practice, and analytics into an ICD-10 preparation program, organizations will be equipped to proactively pinpoint coding roadblocks and address them through focused training, direct coder interaction, and further assessments, providing a customized and comprehensive coder education experience.

Deliver Valuable Education
What constitutes value in an education program depends on the organization. However, certain key characteristics are necessary in any well-designed effort:

• Stay focused. Education sessions should not be a throwback to Coding 101, as coders already familiar with ICD-9 have a strong foundation for understanding the new code set and will discover many guidelines have not changed, although the codes have. Instead, education sessions should focus on guidelines that have significantly changed between ICD-9 and ICD-10, such as tobacco use, so coders are aware of these differences and don’t make faulty assumptions about guidelines they have committed to memory.

• Remain relevant. To maximize education sessions and prevent information overload, trainers should review coder-relevant items, such as frequently used anatomy and terminology, and avoid spending time on historical or trivial factoids, as coders do not need to know who performed the first heart transplant or who invented penicillin to code patient charts.

Prior to the start of education, HIM directors should gather data and identify the diagnosis-related groups (DRGs) that represent roughly 80% of the organization’s DRG volume, including common diagnoses and procedure codes that “move the needle” in terms of revenue for the organization. Trainers should use these organization-relevant DRGs to hone education efforts, skipping over material for procedures not performed at the organization. For example, hospitals that do not provide organ transplants should not educate coders on how to accurately code transplant procedures.

• Support interaction. Whether via webinar or in a real or virtual classroom, a training program should be interactive, including a forum for reviewing guidelines, answering coder questions, and supplying feedback. Because everyone learns differently, trainers should educate coders using a combination of text and narration so coders are both reading and hearing the material. Likewise, sessions should include interactive exercises, where coders periodically walk through a few charts together and have the opportunity to ask questions.

Even if education is offered online, this will provide a much-needed human element, presenting opportunities to discuss what was learned and what is challenging. By offering these interactive sessions, trainers also can effectively gauge coders’ understanding and address concerns as they arise.

Practice, Practice, Practice
With the educational component focused on relevant content, training should be similarly specialized. Coders should practice on real charts using ICD-10 in areas previously identified as most relevant. For example, organizations should leverage charts that reflect the DRGs that represent 80% of the organization’s volume and avoid inapplicable procedures or generic charts.

Remember, coders likely have commonly used ICD-9 codes committed to memory, so it is crucial to emphasize the many similarities as well as the differences between ICD-9 and ICD-10. The more familiar coders are with the guidelines, the quicker it will be for them to identify the right codes. By actually coding real charts in ICD-10, coders can become as efficient and accurate as possible during training, and organizations can prevent coders from upcoding or downcoding—both of which can lead to compliance or reimbursement issues.

Because organizations must keep revenue moving throughout the training period, they need to be intentional in how they allocate time for training, keeping in mind that time spent practicing equals time lost coding. Ideally, coders should spend only two to three hours per week training to minimally impact cash flow and preserve productivity levels. Additionally, training over several months, as opposed to boot camp style, will keep content fresh and easier to digest.

Leverage the Right Tools
Gauging the overall success of a training program is key to ensuring teaching efforts are on the right track. Providing coders with access to training materials is the easy part; making sense of whether training is working is much more challenging and nearly impossible without the right technology. To track, audit, and determine how coding efforts are trending, organizations must enlist a comprehensive training solution that includes or supports analytical tools as well as the ability to measure both productivity and accuracy.

Using these tools, HIM directors can pinpoint troublesome areas causing roadblocks for coders at either the individual or group level. Then retraining efforts can focus on the identified areas to improve accuracy and productivity.

Likewise, analytical tools can be used to conduct time studies with coders as they code real charts in ICD-10. Applying these productivity rates, organizations can forecast how coders will perform at go-live in October. Without these baseline rates and tools, organizations will be left guessing at the short- and long-term impacts of the changeover.

Final Thoughts
In short, organizations must adopt a complete approach to ICD-10 preparation, which incorporates education, practice, and analytics into a winning trifecta for successfully training coders. By offering hands-on training experiences using relevant, data-centric information, in addition to live interactive encounters, organizations will provide meaningful and effective training experiences for coders. Moreover, analytical tools will capture necessary feedback to gauge training effectiveness, allowing organizations to target retraining efforts to improve accuracy and prepare for any productivity gaps. When harnessed together, these elements can ensure an organization’s smooth transition to ICD-10.

— Kim Felix, RHIA, CCS, is director of education for IOD.