Lessons Learned, Best Practices and Recommendations for the ICD-10 National Pilot Program

 Some of the lessons learned from the ICD-10 National Pilot Program include:

• Coders often confused the number “0” (zero) with the letter "O.”

• Coders often confused the number “1” (one) with the letter “l” (L).

• The average accuracy of the coders was 63% based on what was documented from the medical records

• Accuracy was determined based on the answers submitted via the coding response workbook. Answers were determined from matching the answer key to the answers provided by the testing organizations. A grading sheet was used to record the answers provided in comparison to the answer key. Each correct answer was assigned a zero (0) or a one (1) to come up with the % of correct answer.

• Out of the 485 coding submissions from all testing organizations, only 261 submissions by coders of testing organizations included information on time spent coding each medical test case. In addition, the coding process was limited by several variables including logistics.

• Variations in procedure codes were observed due to the expansion of those codes

• Missing procedure codes - occasionally coders coded the diagnosis only but forgot to code the procedures

• Most errors were functional – for example, records not being coded completely or codes being associated with the wrong medical test case numbers.

• Some coders did not specify type of chest pain – what was in the EMR/chart that differentiated it from atypical pains?

• Occasionally coders relied too much on the encoder instead of using their code books—errors occurred when coders went on “auto pilot” mode instead of referring to their code book. This is a problem today that will not necessarily go away with ICD-10.

• Coders should not become so dependent on encoders that they forget when/if there is a need to override.

• Coders were using a non-specific code for a fracture—not allowed in ICD-10-PCS if the diagnostic test results are documented

• Many coders forgot laterality, particularly in the case of pain in a limb; for this diagnosis, four coders out of eight received a zero.

• Coders averaged two medical records per hour, compared to four per hour under ICD-9, which translates to a 50% decline in productivity.

• Coding assignment showed variances which were influenced by hospital policies (ex. Some hospitals coded everything; others coded only what was relevant to the principal diagnosis)

• Logistical issues may have affected the coding time— medical test cases were uploaded into the system right side up but sometimes upside down, and sideways. These limitations and unusual circumstances made it difficult for coders to process the records quickly and therefore could have added to the time it took to code the medical test cases.

• Limitations and challenges include coder conflicts with own work load and personal schedules

• Competing organizational priorities restricted many organizations from participating

• Inability of testing participants to move quickly due to logistics issues (ex. medical test cases were uploaded right side up, upside down, etc.) affected timelines

• Working with limited resources using only in-kind donations affected the timelines and scope

• Technical/logistical issues in uploading coder responses within the Share Point work book slowed down the testing process

• Testing organizations that were fully electronic (EMR fully implemented) had difficulty coding medical records that were hand written—these groups found little value in documents that were not electronically generated.

The entire report is available in PDF:  http://www.himss.org/files/HIMSSorg/Content/files/ICD-10_NPP_Outcomes_Report.pdf

AHIMA: Hospitals lag on ICD-10 planning, steering committees

Author Name Jennifer Bresnick   |   Date June 3, 2013

When AHIMA is worried, hospitals should be, too.  A new survey by the American Health Information Management Association and vendor TrustHCS reveals that hospitals are still struggling to get off the ground when it comes to ICD-10 implementation less than two years before the mandated conversion date.  More than 50% of the 293 healthcare facilities surveyed in the fall of 2012 admitted that they were still in the beginning stages of planning for ICD-10, and 25% hadn’t even appointed an ICD-10 steering committee to head the project.

Teaching community hospitals and academic medical centers fared slightly better than the average, with 30% reporting that they regularly met with their ICD-10 steering committee and were moving through their project plans at an acceptable pace, as opposed to only 17% of other types of hospitals with a plan underway.  Critical access hospitals (CAHs) were the slowest to begin ICD-10 conversion, with the survey’s authors concluding that their exception from DRG-based reimbursement was the likely culprit.

“The move to ICD-10 is a long assembly line requiring a monumental amount of teamwork and coordination,” say Torrey Barnhouse and William Rudman, PhD, RHIA, writing for AHIMA. “Once organizational buy-in is achieved, rapid action with quarterly auditing of progress is a must.”  Buy-in is likely to be stymied by the increased financial burden that ICD-10 will place on hospitals, including funding for coder education.  While the survey found that 72% of hospitals have begun their education programs, it also noted that the cost of these programs averaged$12,200 per coder, with academic medical centers spending closer to $27,000 per staff member.

“Budgets for ICD-10 training are higher within groups who have already established committees and have transition projects underway,” the study notes.  “The researchers behind the study believe this finding indicates that deeper and more extensive ICD-10 education is certainly required by many providers.”  This may come as unwelcome news to budget committees who will be asked for more funding as the true need for financial support reveals itself.  The cost for undertraining will be even higher, however, if claims are denied and revenue streams encounter roadblocks due to poorly coded documentation or ICD-10 mistakes.

Medical coders with ICD-10 experience will have the luxury of choosing from numerous job offers in the next few years as hospitals widely expect to increase their coding staff to mitigate potential dips in productivity.  Sixty-three percent of respondents plan to hire new coders, and 25% plan to outsource their coding needs to staffers working at an hourly rate.  Computer assisted coding (CAC) will supplement the effort in more than three quarters of hospitals, but human experience will be in increasingly high demand.

“This year is a crucial time for organizations to make progress on ICD-10,” Barnhouse and Rudman conclude. “With half of the nation’s hospitals still in the beginning stages, according to the 2012 survey, HIM professionals must dig deeper and push harder to entrench themselves in the implementation process. More than ever, communication and planning are the key factors to a successful transition.”

http://ehrintelligence.com/2013/06/03/ahima-hospitals-lag-on-icd-10-planning-steering-committees/