ICD-10 brings challenges, opportunities to medical coders: Q&A

There are three major components to the ICD-10 transition: physicians and their documentation, payers and their claims processing, and the medical coders that bridge the two.  While each group faces its own particular challenges ahead of October 1, 2014, coders face onerous task of completely reinventing themselves professionally while simultaneously shouldering the burden of keeping their employers’ revenue flowing.  EHRintelligence spoke to Michelle Leavitt, Director of Courseware and Product Strategy at HealthcareSource, a leading human resources management vendor, to discuss some of the issues facing coders as they transition from ICD-9 to ICD-10.

What I’ve heard from customers and the hospitals that I’ve worked with is that it’s primarily an issue of time.  Hospitals have people who are working with ICD-9, and all of those people in the current workforce, almost 200,000 of them, need to learn how to do what they do with ICD-10 instead of ICD-9.  And they need to learn that information while they’re still doing their full time job.  So hospitals are really struggling with figuring out the right way to provide that education to their employees.  They also need to figure out how to do it in a way that their employees are happy with.  None of these workers want to spend their weekends at a seminar.  Nobody wants to do that.

Online education is a good way to provide that information.  It’s convenient.  A lot of coders work remotely or work from home, so being able to access online courses from anywhere is great.  And they can fit it in to their schedules when it makes sense for them.  If they have a little bit of downtime for twenty minutes or an hour on a Tuesday, they can spend that time doing some education, and then pick it up again later on when they have another opening in their schedule.

Another really nice advantage of e-learning is that there are assessments that let employers test an employee’s level of knowledge.  Some of these coders are recent college graduates, and may have learned something about ICD-10 already.  Other coders haven’t had formal education for twenty, thirty, forty years, and know nothing about ICD-10.  So you can really pinpoint what a coder knows and what she doesn’t, and then only have that individual complete the education that she needs, rather than having everyone go sit in a room for eight hours going over things they might already be familiar with.

I see coders being really excited about it.  I don’t see organizations being that eager.  People in human resources and organization development have a lot of things on their plate, and this deadline that’s a year away isn’t yet as much of a burning issue as it needs to be.  I would certainly encourage HR departments to make sure that this is a priority, and if they haven’t already, start to offer education to the coders.  That will help with staff retention.  If a coder can get ICD-10 education at the hospital where she’s working today, then she has no incentive to leave and go to another organization that will give her that edge.

AHIMA recommends that inpatient coders receive anywhere between 57 and 62 hours of training to get ready for ICD-10.  So the sooner that an organization starts having employees start the education, the more time they’ll have to spread it out, so it won’t be a situation where next summer, coders have to take significant time out of their day-to-day work to do this training.

The biggest challenge with ICD-10 is the requirement for more detailed knowledge of the human body.  The codes are a lot more complex, and there are a lot more codes for each type of injury or symptom or diagnosis.  So a big part of getting ready for ICD-10 is having coders learn or re-learn college-level anatomy and physiology (A&P) and medical terminology.  That’s where the biggest part of the education is going to come in.  Coders don’t really need to know that much about A&P right now in ICD-9, and most of the people in the coding workforce have either never been educated in A&P or haven’t had an A&P class since they were in college, which again, for many of these individuals was quite a long time ago.

Once the foundation of that knowledge is there, it’s a matter of practicing through case studies.  The ICD-10 codes are different.  They’re much more alphanumeric.  ICD-9 codes were primarily numbers, with maybe one letter, but ICD-10 is multiple letters, multiple numbers.  They have seven digits instead of three or four.  So it’s just a lot more complex to look up and find the right code.

I think it’s going to be dependent on the investment that the hospital has made in its people in advance of October 1, 2014.  Those hospitals that have taken the time to prepare their coders will see a lower productivity impact.  Those hospitals that wait to start the training process and try to cram it in at the last minute, are going to see a much bigger hit, because their coders aren’t going to be confident in using ICD-10.  They’ll take more time to check and double check their own work, and they won’t have had as much practice, so they won’t be as quick to use ICD-10.

I would say don’t wait.  It’s easy to put this off – hospitals have a lot of other priorities, certainly.  But the longer organizations wait to start on this, the more they will pay for the delay next fall.  It’s like an EHR implementation.  The EHR implementation was initially viewed as an IT issue, or a software issue.  But it turned out that it was a big initiative for everyone in the organization.  ICD-10 is very much the same way.  This isn’t just an issue for coders, and it isn’t just an issue for your IT staff.  It’s an issue that will affect everyone, and if the organization views it as a major strategic initiative, and gives it the right attention, then they will be better prepared and have fewer negative impacts.