Dual coding refers to the coding of both ICD-9 CM/PCS and ICD-10 CM/PCS codes on the same patient health record. Despite the obvious initial loss of productivity during implementation of such a process, a properly executed and well-designed dual coding strategy should be a key component of your organization’s ICD-10 transition program. If you haven’t started already, beginning your planning today for dual coding is a must and will greatly improve your organization’s position in regards to the challenges of the switch to ICD-10.
Below are a few reasons implementation of a dual coding strategy is critical:
· INCREASED CODER PRODUCTIVITY. Dual coding will increase coder productivity after the mandatory ICD-10 compliance date – particularly boosting productivity levels during the critical 6 month period following mandatory compliance, which is when the most problems are predicted. This practice in coding both code sets, no matter if it’s just a few records a weeks, on actual patient health records, will pay dividends in terms of both coder familiarity with ICD-10 and speed in coding charts.
· INCREASED CODER CONFIDENCE. By practicing on real patient charts, dual coding will increase your coder’s confidence, eliminating potential the type of deer in the headlights moments that happen to many individuals when facing transitions to new systems and processes.
· PREPARATION FOR KEY TRANSITIONAL REPORTING. Reporting that spans across the ICD-10 compliance date will potentially mean reports with inconsistent code sets (ICD-9 before and ICD-10 after). The GEMS crosswalk, which serves to link the code sets, lacks the clinical rules necessary to accurately map many diagnoses and procedures. This may not be a problem for some reports, but for other reports problems with the inconsistencies may exist. A well-thought out dual coding strategy can eliminate this headache in critical reporting areas that span the ICD-10 compliance date by allowing reporting in either ICD-9 or ICD-10.
· REVENUE REIMBURSEMENT ANALYSIS. Although CMS has stated they are trying to make ICD-10 revenue neutral, early analysis indicates this will not be the case, meaning your facility should plan and budget for the impacts accordingly. Dual coding can allow for this type of revenue reimbursement impact analysis by enabling your financial management team to develop strategies tailored to your organization. For example, proper budgeting for your most critical service lines and highest-volume patient stay types.
· SAVE ON TRAINING COSTS. Dual coding can allow cost savings on any external coder training programs your organization chooses to participate in. For one, dual coding is training – the best kind there is, because it’s actual patient charts. Secondly, many of the packages offered by training companies have assessment and exam pieces. Coding on real patient charts will provide the same sort of benefits as these assessment pieces. Of course, having an experienced coder or coding director well versed in all areas of ICD-10 on staff will be necessary for to capitalize on this benefit.
· CODER READINESS ASSESSMENT. Dual coding can allow coding directors to assess their coder’s readiness status and make changes as needed, while also keeping other stakeholders apprised of the situation and any additional preparations that may be needed as a result. Determining which of your coders or coder-types need the most help for ICD-10 prior to the transition date will be critical to avoid unnecessary explosions in DNFB.
- PHYSICIAN DOCUMENTATION ASSESSMENT. Probably the most important benefit of dual coding is that it will allow your coders to identify problem areas and shortcomings in physician documentation. Discovering trends in these shortcomings can enable clinical documentation improvement to take place preemptively. Using dual coding as a key component in a feedback loop on your hospital’s actual patient records can also lead to more targeted physician training. Moreover, your dual coding strategy can serve as a powerful method to open up critical communication lines in your larger clinical documentation improvement program, engaging physicians in a culture that stresses the importance of detailed documentation. If properly implemented these benefits might begin today, providing benefits in addition to better ICD-10 preparedness.
Yet to take advantage of these benefits, your organization must begin taking the proper steps today. A general path for a successful dual coding strategy is provided below:
First, an IT assessment must be performed to determine system capability; different vendors are handling the transition to ICD-10 differently. Many of the vendors still don’t understand what true dual coding is; therefore, verification is imperative. For example, we have had vendors inform us that being able to handle one code set or the other is dual coding, which is clearly not the case. What you should focus on finding out is if your encoder and main HIS can handle dual coding. This situation means you’ll be in good position for an automated strategy. If not, additional time and planning will be needed to work out a more manual process.
Second, your coding team will need to be trained on ICD-10 in great detail. Coders lacking knowledge in anatomy and physiology will also need that training to code with the more detailed ICD-10 codes. Having a “Super User” or certified trainer well-versed in all areas of ICD-10 will also be crucial. All of this training should be completed prior to the actual dual coding of patient records, although certainly any missed training identified should continue after the process has begun.
Third, decisions will have to be made regarding how to allocate hours so as to minimize the effects of losses in productivity. Will your staff need overtime? Will additional coders’ services need to be retained? Will adding a contract coder or remote coder be necessary for effective implementation?
Finally, the scope of dual coding will have to be delineated and prioritized. Coding all patient encounters in both code sets is both cost prohibitive and impractical. Decisions will have to be made whether to dual code retrospectively or prospectively. And perhaps most critically, choosing which types of accounts to code in both code sets will not be an easy decision. A multi-disciplinary committee will need to be tasked with identifying those chart types most critical to your organization’s financial health and mission.
As one can see, reaping the benefits of a well-designed dual coding strategy will take significant planning and strategic decision making. But with over 2 years until the ICD-10 transition date, beginning your planning today, can make the task easily surmountable and leave your organization well-positioned for the transition to ICD-10.
Matt Wimberley
Consultant
Strategic Advisory Services
MattWimberley@SantaRosaConsulting.com