ICD-10 Planning: Dual Coding Best Practices

Medical bill and stethoscopeMany healthcare provider organizations are frustrated by the ICD-10 delay, and with good reason. A recent CHIME study indicates that many hospitals are incurring large expenses and have slowed down their ICD-10 preparations because of the delay (more on that next week). While every hospital and ASC must decide on their own ICD-10 transition schedule, those that forge ahead with preparations will be best positioned to leverage the benefits of ICD-10 coding.

Of the multiple elements that go into an ICD-10 transition strategy, among the most meaningful is implementation of a dual-coding program.  The information and experience derived from temporarily coding in both ICD-9 and ICD-10 can mitigate productivity declines in the immediate aftermath of the changeover, pinpoint documentation weaknesses, and identify bottom line-impacting diagnosis-related group (DRG) shifts.

The greatest benefits of dual-coding will be realized by the HIM team. Coders can achieve proficiency with ICD-10 codes and familiarize themselves with the rules and codebooks that guide code selection. Dual-coding also reveals documentation lapses and gaps, which will drive improvement and education strategies.

Get Familiar with Finance
Beyond HIM, dual-coding is also highly beneficial to the finance side of the house. Finance teams can use the information to make sure payers—who are under the same pressure and deadlines as providers to complete the transition—have updated policies to include all appropriate ICD-10 codes to ensure prompt reimbursement. It can also reveal contracts that will require renegotiation to establish new reimbursement levels under the more granular code set. Finally, dual-coding can ensure that the correct ICD-10 codes are included in DRG groupings, which drives appropriate reimbursement.

When designing dual-coding programs, work closely with the finance team to identify DRGs with the highest reimbursement value and/or denial rates. Ensuring coders are experienced with these charts in particular can help keep the revenue cycle humming under ICD-10.

Work on Workflows
To derive full benefits from a dual-coding program, it must be designed with workflow in mind.  One common approach is to simply have coders re-code all charts in ICD-10—which is inefficient and often winds up creating an ICD-9 backlog that brings the revenue cycle to a screeching halt. Not to mention the reality that most hospitals are already struggling to stay ahead of coding volumes thanks to the ongoing coder shortage.

A more workflow-friendly approach that provides coders with maximum exposure to ICD-10 without contributing to backlogs is to identify a sampling of DRGs that best represent the hospital’s typical case mix, or to set specific days during which coders will code in both ICD0-9 and ICD-10. The latter is particularly effective because it exposes coders to a wide sampling of different chart types while still enabling them to maintain ICD-9 productivity levels.

Variety is important when it comes to ICD-10. Some sections, such as orthopedics, are significantly different than ICD-9 with more codes and greater detail. Many coders cross-code between departments and it’s important that they be able to do the same when working with the broader and more complex ICD-10 code set.

Leverage Automation
Finally, hospitals and other healthcare organizations that have automated documentation and coding processes with ProVation Medical software will find dual-coding—and the transition to ICD-10 in general—less onerous because our solutions are already ICD-10 ready. To start coding in ICD-10, hospitals need only to turn on the functionality.

Ultimately, hospitals that implement dual-coding programs will be best prepared to succeed in an ICD-10 environment. Providing coders with the opportunity to practice their ICD-10 skills will help them retain their training and keep them motivated and enthusiastic about the transition despite the repeated delays. The documentation weakness and claims issues dual-coding reveals will also help mitigate the expected productivity and reimbursement declines, helping hospitals bounce back more quickly post-transition.


Learn more by downloading our white paper, Easing the Transition to ICD-10: The Role of Automated Procedure Documentation and Coding Solutions.