Evaluating Technology to Attack ICD-10 from a Coding Perspective

Paper versus Electronic - Which Path Do you Choose?

By Maria T. Bounos, RN, MPM, CPC-H  Business Development Manager, Wolters Kluwer Law & Business

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The count down continues with ICD-10 as all certified coders are tasked with becoming fluent with the new coding system.  With October 1, 2013 in sight, many will be preparing to take ICD-10 certification exams as part of certain coding association requirements.   Paper versus electronic are two paths coders face as they begin to think about an attack to ICD-10; which path should you choose? The use of the word “attack” is literal as every U.S. organization is faced with transitioning from roughly 60 thousand codes in ICD-9 to more than 150 thousand codes in ICD-10.  The numbers are overwhelming.  So overwhelming that many seasoned coders have stated that they will retire before ICD-10 is implemented. Being that many coders are “visual” in nature, many believe that paper is the only option, specifically since those that will be sitting in to take the ICD-10 certification exam will need to use a paper ICD-10 codebook.  

Whether you are a coder, HIM director with coding staff, or part of an ICD-10 risk assessment committee; do you know how you, your team and/or your organization is going to attack learning the ICD-10 CM and PCS coding systems?  Many may default to paper codebooks, but if you think about coding from a workflow perspective, it makes the most sense to take advantage of today’s technology.  There is no need to choose one or the other. You can pair them together as a plan of attack and look for electronic tools that can assist coders learn how to use the required paper codebook.

From a broad prospective, aside from the paper code book option, the types of ICD-10 workflow tools to consider for an organization are those that will assist in learning the actual code sets, assist in current workflow activity to translate codes from I-9 to I-10, and assist in learning ICD-10 from a regulatory standpoint and possibly subscribe to electronic educational courseware, specifically those that have a strong focus in anatomy and physiology. There are options out there in the marketplace and it seems as though when speaking to organizations, they have multiple tools that may accomplish some of these similar objectives. Take a moment to assess the coder’s workflow. You will soon realize how an organization can easily decrease coder apprehension in learning the new coding system, increase coder longevity and productivity as well as save money at the end of the day, if you choose coding workflow tools wisely.  

Workflow Tool Analysis

Workflow tools from a coding perspective should provide the following in one easy-to-use tool:

Coding – Assure that electronic code books are available and contain both ICD-10-CM and PCS.  The CM electronic codebook should be comprehensive with guidelines and indexes and the PCS e-codebook should include guidelines, indexes, and a reference manual.  The electronic code books should be paired with some type of ICD-9 to ICD-10 translation tool.  The translation tool should assist the coder in analyzing current code sets under ICD-9 in comparison to those in ICD-10. 

Regulatory Resources – Correct Coding is driven by regulatory information.  Providing access to CMS notifications and regulatory issuances, such as The Federal Register & CFR will be the key to a coder’s success.  Additionally, the coding workflow tool should have the capability to offer and anticipate the addition of local and national coverage determinations as well as updates to the ICD-10 coding system in the form of CMS manuals and transmittals.  Be prepared as Payers and CMS will soon provide the direction for accurate claims submission as we continue to move forward into ICD-10. 

Education - Electronic educational courses paired with coding and regulatory information can be very powerful in assisting the coder tie it all together.  Courses should include not only a comprehensive overview of the ICD-10 coding system but components related to Anatomy and Physiology, clinical implications and medical terminology due to the specificity in coding with ICD-10.  

Evaluating Technology

Evaluating technology to facilitate learning ICD-10 code sets is not an easy task, yet the technology should be able to do the following from a coding workflow perspective:

• The electronic translation tool should allow the end user to perform a simultaneous KEYWORD search of ICD-9 and ICD-10 for direct comparison and not just by code(s) searching. 

• Provide TRANSPARENT access to the General Equivalent Mapping (GEMS) and reimbursement maps, so that the search results are obvious and are a direct search result to include forward and backward mapping.

  **Many have argued and agreed that coders should not use GEMS to code or have access to the reimbursement maps. The GEMS and reimbursement maps should serve solely as a GUIDE for coders and should not be seen as a replacement to learn or influence the new coding system. 
   

• Provide access to understanding the IMPLICATIONS of ICD-10 on MS-DRGs, via an interactive MS-DRG Grouper.

• Present current and archived guidance to assist coders in understanding how ICD-10 IMPACTS other coding areas, such as the Claims Processing and Benefit Policy rules by Medicare or National and Local coverage determinations.

• Include FREE training and support. This is an unfunded mandate from the government. Although development is an incurred cost by vendors for these workflow tools, institutions should not be burdened with software installation and training costs.

Choose to be a leader in learning ICD-10 and pair paper codebooks with electronic tools to facilitate the transition.  The use of electronic coding workflow tools will not only improve efficiencies and lower administrative costs; but reduce coding errors and claim rejections.  Leading to an organizational enterprise goal to be in compliance and submit clean claims correctly the first time. 
 

About the Author

Maria joined Wolters Kluwer in the fall of 2007 and is currently the Business Development Manager for Regulatory and Reimbursement software solutions. She began her career at WK as Product Manager responsible for product development, maintenance, enhancements and business development and now solely focuses on business development. She has more than twenty years of experience in healthcare including nursing, coding, health care consulting, and software solutions.

Her experience includes specializing in regulatory compliance, reimbursement, and process improvement as she has led improvement projects that have delivered significant financial benefit for large academic medical centers as well as mid-sized community hospitals and critical access hospitals. Prior to joining Wolters Kluwer, Maria was a Senior Manager with GE Health care and led large revenue cycle projects, developed service line offerings and mentored consultants.

Prior to GE, Maria was Vice-President Operations for a national managementconsulting firm, specializing in reimbursement, operational improvement, and regulatory issues. The firm provided on-site consulting services as well as web-based applications to help hospitals review and maintain their charge description master (CDM), outsource CDM management, perform outpatient and inpatient coding compliance reviews, and assist in answering corporate integrity agreements.
In this role, Maria was responsible for developing and maintaining the operating budget, developing and implementing the training program for new employees, sales and implementation of web-based applications, and being the client executive for onsite engagements, as well as, providing consulting services to clients.

Maria has a Masters Degree in Public Management with Concentration in Health Systems from Carnegie Mellon Universityand a B.S. degree in Nursing from Carlow College. She is a contributing writer for CCH’s Law, Explanation and Analysis of the Patient Protection and Affordable Care Act; Including Reconciliation Act Impact 2010 and regularly contributes articles for the CCH & MediRegs Coding Compliance Advisor Newsletter, HIMSS ICD-10 playbook and ICD-10Monitor.com. Her most recent speaking engagements include topics related to Computer Assisted Coding, ICD-10, NCCI and OIG Initiatives.

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