March 2014

Don’t Quit!
By Judy Sturgeon, CCS, CCDS
For The Record
Vol. 26 No. 3 P. 8

Since it first became evident that ICD-10 wouldn’t be delayed for eternity, talk around coding department watercoolers has featured entirely too many pronouncements that the speaker intends to retire—or at least quit coding—when the big day arrives.

One piece of advice: Don’t do it! While I admit that I was one of the people who planned to abandon ship at the dawn of destruction (aka, the start of ICD-10), I have since come to my senses. Others should follow suit.

Let’s face it: Coders don’t like change. We’re in this business because we like order, logic, and rules. Now some pushy gang of data do-gooders wants to throw out all the rules that we’ve taken a lifetime to learn and expects us to stick around to basically start from scratch? Not many senior coders are wildly attracted to that offer.

There are plenty of ICD-10 terrorists who take great pleasure in scaring coders and doctors alike, soaking up all of the attention they can generate in the process. Vendors can add to the fear: “The sky is falling, the sky is falling! Buy our stuff!”

But let’s put them in the closet for a while. Data disaster-philes have been just fine in there since Y2K didn’t make planes fall from the sky, so they can stay in that spot long enough for us to consider some of the reasons coders may want to continue to ply their trade and perhaps, in time, even embrace ICD-10.

Don’t Be Intimidated
CM (clinical modification) and PCS (procedure coding system) have quite different challenges. But consider this: If a coder can learn ICD-9 and/or CPT, why not ICD-10 too? Of course coders can learn a new system, especially one based on three of their most favorite concepts: language, logic, and rules. Yes, there are new rules, but so what? In CPT and ICD-9, coders have had to learn new codes and coding rule changes every year. Plus, more learning is required every time a payer decides to publish its own rules for submitting claims in both code systems.

ICD-10-CM uses the same concepts as its predecessor. There are a few rule variations, but the format is the same. Know the conventions, look up the terms used by the physician in the index, follow the directions, proceed to the tabular section, follow those instructions, and assign the code.

There are two types of excludes notes instead of one, but that actually makes coding easier because any ambiguity essentially is eliminated. Are there more levels of subterms in the index? Does the provider need to give more details than for ICD-9? Definitely. But is that really going to confuse any professional coder? It shouldn’t.

I’ve felt much more at ease about CM since I learned that a high percentage of the new codes are “left, right, bilateral.” In addition, a high percentage is specific to the cause of injury. In the case of the former, the documentation challenges aren’t overwhelming; the information usually is present or fairly easy to obtain. In the latter’s case, how often will there be a need to code “hit by a tidal wave while ice skating as part of a volunteer activity in a sports stadium”? Eliminating these from the worry list quells a lot of the fear surrounding the number of ICD-10 codes.

PCS is a different kind of challenge, though. Despite there being an index like in ICD-9, a practical approach to PCS is more like build-a-procedure rather than simply translating the physician’s medical terminology into a directly related and similarly described code. The good news is coders don’t have to learn PCS on their own; there’s plenty of free educational materials available on the Centers for Medicare & Medicaid Services website. Also, comprehensive codebooks (Optum Professional, for example) contain valuable information as well as case examples for testing purposes.

For coders who prefer a classroom setting, several professional associations and vendors have organized a series of sessions dedicated to getting ICD-10 neophytes up to speed. Another option is Web-based training modules, which may be more labor intensive but cost less.

There Are Options
Another reason not to throw in the towel: money. The salaries of contract coders are on the upswing, and the need for good in-house coders continues to climb, leaving smart managers no choice but to keep up with local wages if they want to maintain staff levels. Also, skilled ICD-10 coders can explore more lucrative careers as auditors or trainers.

But if joining the ICD-10 universe as a production coder or auditor is just too much to bear, now may be the time to consider moving to an ancillary profession that requires less additional education. For example, a physician’s office may be an ideal setting. Coders still will need to learn CM, but PCS no longer is a concern.

There’s also the option to move to a specialty-based office where, instead of learning every ICD-10-CM and PCS code, coders need to be proficient only at a particular set of rules. And clinical documentation improvement is another fertile field for coders who want to work on the front end of the documentation trail.

The data management and data mining fields present disenchanted coders with other opportunities as well. ICD-9 isn’t vanishing into the sunset; research and reporting based on its data will continue for many years. Coders with skills in those areas can find decision-support and quality assurance positions with payers, software development companies, and the NSA (ha-ha). Still, coders well versed in ICD-9 who master ICD-10 well enough to be able to translate between the two systems will find their services to be in demand.

Keep on Keeping On
There’s more good news for coders willing to stay the course: Those Coding Clinics from the 1980s that coders still need to recall will no longer be of importance. This is something to celebrate on two levels. First, it levels the playing field for coding newcomers who won’t have to memorize “ancient” history to be current. For veteran coders, no longer will it be necessary to remember 30 years of quarterly publications.

Need more encouragement? Don’t discount the wonders of coding software, whose features include complete reference manuals, coding edits, and even pop-up warnings in case a rule is forgotten. The best software programs accelerate learning, and once coders understand ICD-10’s structure and rules, they can deliver charts at a greater rate.

Coders must confront ICD-10. While it takes nerve, it’s probably a lot less intimidating than the fear levels that seem to be prevalent throughout the profession. Those who have held their own in ICD-9 shouldn’t let the fear of change dissuade them from continuing their careers.

If ICD-10 latecomers get started immediately, there’s still time to become proficient at a reasonable pace before October. But don’t put it off. Give it a try—you may like it and later be glad you decided to stick around.

— Judy Sturgeon, CCS, CCDS, is the clinical coding/reimbursement compliance manager at Harris Health System in Houston and a contributing editor at For The Record. While her initial education was in medical technology, she has been in hospital coding and compliance for 22 years.