ICD-10 Dual Coding – Stay the Course

EdwinHartai5 Key Reasons to Keep on Schedule

By Edwin Hartai, Senior Consultant,  Hayes Management Consulting
Twitter: @HayesManagement

The delay of ICD-10 has caused healthcare providers to re-evaluate the time and costs associated with planning and implementation efforts, including those devoted to dual-coding. President Obama signed the SGR bill (H.R. 4302) on April 1, 2014, effectively delaying ICD-10 until October 1, 2015 at the earliest. Many organizations were just getting their dual coding efforts underway and others were trying to give their coders at least six months of practice to minimize the impacts on productivity following the implementation of ICD-10.

Onward and upward – Why stay on track?

Although the delay of ICD-10 may cause many providers to halt or reduce their dual coding efforts, there are five key reasons why moving forward as originally planned will help reduce risks and better prepare organizations for ICD-10. The following go well beyond getting coders comfortable with ICD-10 and addressing the learning curve:

  1. Better trained and efficient staff. More time spent dual coding will help increase efficiencies coding in ICD-10 and build coder confidence. Effectively tracking and monitoring coder accuracy and productivity while dual coding also allows for a better ability to budget for additional coding resources both initially and ongoing.
  2. Ability to identify and address documentation gaps. Dual-coding will help to provide meaningful feedback to physicians on identified gaps and weaknesses in their documentation to effectively support accurate ICD-10 code selection. Depending on the timing of physician education, this will also help assess the success of the ICD-10 training program(s) and identify coders, providers and services that may need additional training. Dual-coding may also help to better estimate the need for additional Clinical Documentation Improvement resources based on the volume of additional queries under ICD-10.
  3. Better data for financial impact analyses. Using cases that have been dually coded using actual documentation will help to provide more accurate claims for financial impact analyses. The more cases that can be dually-coded will help to achieve better sample sizes and help organizations to move beyond just their top 100 cases. Financial impact analyses that were originally completed using data that was forward mapped between ICD-9 and ICD-10 can be refined based on actual dually-coded cases for more accuracy and better identification of potential DRG shifts.
  4. Better data for reporting. Similar to item three, dually-coded data will help to make sure that reports spanning the ICD-10 implementation date are pulling information correctly and reports can be more fully tested using dually-coded data.
  5. Better data for unit, integrated, end-to-end and payer testing. Many organizations have been using forward mapped data to create test cases for ICD-10, both within and across systems. Using dually coded cases may help to better identify mapping issues, identify code translation issues within and across systems, and for interface testing. Dually-coded data can be used to create test data for payer testing based on actual cases.

Reduce risk and minimize financial exposure

Although there are costs associated with dual-coding, primarily around the resources required to code records in both ICD-9 and ICD-10, the benefits of these five key reasons may help many organizations to re-coup those expenses in the long-run by reducing risk, minimizing financial exposure and identifying and resolving issues sooner rather than later.

About the Author: Edwin has more than 23 years of health industry experience focusing on hospital and physician practice revenue cycle operations, information systems, patient access and patient accounting, performance improvement and facilities management. Edwin is now a Senior Consultant for Hayes Management Consulting, where he has recently helped to develop and deliver ICD-10 tools and methodologies to their clients. Edwin’s background includes working for a “Big Four” accounting firm, with experience leading revenue cycle assessments, redesigns and implementations as well as working on the provider-side for over 10 years in health system operations.

This article was originally published in Hayes’ Healthcare Blog and is republished here with permission.