*

ICD-10 Implementation and

Training
HIA 340E
Management and Organization for Health Professionals
By Amanda Foster, Erin Frankenberger and
Michelle Wisniewski

ICD-10 PCS-CM Clinical

Coding
* The World Health Organization published the

International Classification of Disease Set and,

in 1990, updated to ICD-10.

* All covered entities as per HIPAA will be

required to use ICD-10 codes beginning October

1, 2014.

* This change will affect anyone who uses health

care information that has a diagnosis and/or
inpatient procedural code.

Why ICD-10?
* The limitations of the current ICD-10 codes,

which include outdated terminology,

overcrowding of codes in ICD-9 categories, and
insufficient detail, has made an upgrade to
ICD-10 a necessity.

* ICD-10 is a more detail orientated and up-todate code set that will improve both the
accuracy of coding and reimbursement.

Benefits of ICD-10
* Increased detail of codes will improve payment
processing and reimbursement.

* Enhanced and more specific coding to categorize

anatomic site, etiology and severity of disease.

* Terminology and disease classifications now mirror

current medical practices and advances in
technology.

* More detailed data will allow for improved analysis

of disease patterns and the tracking and responding

to public health outbreaks.

ICD-10 Implementation
Timeline
Winter 2012

Form ICD-10 steering committee.

Representatives should be included from the following

disciplines: Administration, Billing, Health Information
Management/Coding, Information Systems, Revenue Cycle
Management, Ancillary Services, Emergency Department,
Nursing, Medical Staff, Pharmacy and Therapies.

Perform an impact assessment and identify prospective

changes to current workflow and business processes.

Collect information from hospital departments regarding who

will need to be trained in ICD-10 and to what extent.

Timeline, Cont.
Begin developing a budget that includes software and
software license costs, purchase of hardware, and
training costs.

Begin communications with 3M, clearinghouses and billing

departments regarding their readiness with ICD-10.

Research anticipated time for testing and availability.

Work with 3M to start internal system design and

development.

Begin educating staff on ICD-10 and relevant

documentation changes.

Timeline, Cont.
Begin and complete system design and development.
Begin conducting internal testing coordinating effort with
internal coding, billing, IT and 3M.

Office and provider staff should begin working with IT to

start implementation of ICD-10 project plan for the

course of ICD-implementation. Activities include review
of sample data reports, testing and accuracy evaluation.

Spring 2013

Continue staff education on ICD-10 and relevant

documentation requirements.

Timeline, Cont.
Office staff should continue working with IT

to
implement the ICD-10 project plan for the course of ICDimplementation. Activities include review of sample data
reports, testing and accuracy evaluation.

Summer 2013

Continue staff education on ICD-10 and relevant

documentation requirements.

Continue internal testing and 3M code deployment.

Office and provider staff should continue working with IT
to implement the ICD-10 project plan for the course of
ICD-implementation. Activities include review of sample
data reports, testing and accuracy evaluation.

Timeline, Cont.
Fall 2013

Complete staff education on ICD-10 and relevant

documentation requirements.

Complete internal testing and 3M code deployment.

Initiate external testing process.
Office and provider staff should continue working with IT
to implement the ICD-10 project plan for the course of
ICD-implementation. Activities include review of sample
data reports, testing and accuracy evaluation.

Timeline, cont.
Winter 2013

Continue external testing process.

Office and provider staff should continue working with IT
to implement the ICD-10 project plan for the course of
ICD-implementation. Activities include review of sample
data reports, testing and accuracy evaluation.

Spring 2014

Continue external testing process.

Begin intensive training program for coders (6 months).

Timeline, Cont.
Office and provider staff should continue working with IT

to implement the ICD-10 project plan for the course of ICDimplementation. Activities include review of sample data
reports, testing and accuracy evaluation.
Summer 2014
Complete external testing process.
Work with 3M to transition ICD-10 systems to production.
Continue coder training program.
Office and provider staff should continue working with IT
to implement the ICD-10 project plan for the course of ICDimplementation. Activities include review of sample data
reports, testing and accuracy evaluation.

Timeline, Cont.
Fall 2014

Work with 3M to complete transition ICD-10 systems to

production.

Complete coder training program.

October 1, 2014: ICD-10 implementation complete.
Systems are fully in compliance. *ICD-9 codes will continue
to be used for services rendered prior to October 1, 2014.

Post Implementation
Strategy
* After implementation, the ICD-10 steering committee will
continue to meet on a monthly basis to evaluate ICD-10
success.

* Included in this evaluation will be a review of reports of

coded data accuracy and quality to assess the need for
continued staff training.

* A study will begin on actual vs. planned progress,

reimbursement, denials and rejections, and fraud and

abuse monitoring.

* A plan will be formulated to quickly address and resolve

these issues.

Approximate Budget
* It is estimated that the overall implementation of 1CD-10
and training process will cost approximately 15 million
dollars.
Expense categories:

* Implementation ( Training, hardware, software, support )

* Management ( loss revenue/ productivity)

*Detailed Expenses
* Training: classes, software, travel, materials,

books
* Outsourcing: trained coders to fill gaps in the
transition
* Hardware: software modifications or
adjustments, vendor fees, test server,
workstations, and testing stations
* Software: any software upgrades, new
software systems, programming, test
applications

*Detailed Expenses
* Loss of Revenue:
1) Coding Productivity may decrease due
to additional time needed to code patient charts
2) There may be an increase in claim
rejections
3) Slow responses for payment

*ICD-10 Steering
Committee

* An interdisciplinary steering committee will be

established to oversee the implementation of
ICD-10 and training.

* Members of this committee will include HIM,

HIM coding professionals, senior management,

medical staff, financial management and
Information Technology.

*3M 360 Encompass System

* Medaille Healthcare System will utilize 3Ms
ICD-10 software.

* Includes ICD-10 readiness tool with complete

ICD-10-CM and ICD-10-PCS coding content

* Features include code entry and retrieval

* To increase coding accuracy; anatomy images
are integrated with coding workflow

* We will also incorporate Computer Assisted

Coding (CAC) software to increase productivity

and accuracy through the use of Natural
Language Processing (NLP)

*Internal and External Auditing

* Internal testing will be
done within Medaille
Healthcare System to
determine if the
software was installed
successfully

* Process takes 2-3

months

* External testing consists

of trials where we will

send and receive
transactions that include
ICD-10 with the billing
department and payers
to ensure the software is
functional

* Process takes 3-6 months

There will be annual internal and external auditing of clinical coding,

provided by 3Ms Registered Clinical Coding Auditors

*Chargemaster (CDM)
* The charge description master is a database of
services provided to patients and their cost.

* CDM:

ensures accuracy of data, improves

reimbursement

* Avoids undercharging or underpayment ,any

rejected claims, penalties and fines

* Included in the CDM are descriptions of CPT

and HCPCS codes, revenue codes, department

codes, charge codes and charge status

*Chargemaster Committee
* Includes:
1) Physicians
2)Representatives from HIM
3) Financial Services
4) Representatives from radiology, laboratory,
nursing
Responsibilities: Include the development of
policies and procedures for the chargemaster
review process and the annual review.

How Will ICD-10 Affect

Cash Flow?
* To ensure that cash flow disruptions are kept
to a minimum, we will outsource trained
coders from Kforce Healthcare.

* These trained coders will pick up the slack

while Medaille Heathcare Systems coders are

undergoing training.

Staff Training
The Medaille Healthcare facility consists of the
hospital and two ancillary departments (radiology and
a lab). It is also associated with a physician group.
There are many different departments that will need
to be trained.

The level of training will vary depending on access

with coding professionals being the most detailed.

Staff Training, cont.

The following departments and staff will need to
undergo ICD-10 training:

* Health Information Management Staff

* Billing/Financial Office
* Accounting Professionals
* Corporate Compliance Office Staff
* Quality Management Staff
* Auditors
* Clinicians/Nursing Personnel

Staff Training, cont.

* Clinical Department Managers
* Utilization Management Staff
* Patient Access and Registration Staff
* Researchers
* Ancillary Department Staff

(physical therapists, occupational therapists, respiratory

therapists, radiologists, lab technicians)

* Visiting Nurses

* Hospice Professionals
* Outpatient Service Billing Personnel

Staff Training, cont.

* Data Quality Management Staff
* Data Security Personnel
* Internal and External Data Analysts
* Information Technology and Information Systems
Personnel

Staff Training, cont.

According to the American Hospital Association and
AHIMA, the HIM managers and coders will need the most
intense training. Those coders who assign diagnosis
codes will need training on the guidelines, definitions
and methodology for using ICD-10 CM. Those who have
the task of assigning inpatient acute care procedure
codes will need to be trained to use ICD-10 PCS. AHIMA
estimates that coding staff working who assign diagnosis
codes will require 16 hours of training and those coders
in in-patient hospitals will need approximately 50 hours
of training since they need to learn both ICD-10 PCS and
ICD-10 CM. Coding staff should complete their training
no more than 3-6 months before the implementation
date.

Staff Training, cont.

Physicians, physicians assistants, nursing,
researchers, ancillary staff, billing, administrative
staff, coders and vendors should all have a basic
understanding of ICD-10, knowledge of ICD-10
definitions and terms and ICD-10s effects on clinical
documentation. Physicians, PAs, nursing, ancillary
staff and IT staff must be trained to use the new
software that previous systems will be updated
to. Physicians will also need to be educated on the
importance of accurate and complete
documentation.

*Training for ICD-10

*NON- CODING STAFF= 4.5-7 hours of
training material in 2 stages

*STAGE I- Awareness, implementation

preparation and readiness. Explanations on

how organizations will be affected

*STAGE II- Foundations, coding systems,

instruction and implementation tools. Covers

basics and introduces ICD-10

*Training for ICD-10

* Mandatory training sessions- In the format
suggested by AHIMA because it is geared
toward each profession.

* Training timeline is two years, from 2012 2014

* We are aware there are several different
learning styles, and therefore there will be a
few different options available

*Training for ICD-10

*ACUTE CARE= 58-66 hours of training in 4
stages

*STAGE I- Overview of ICD-10 and introduce

training course

*STAGE II- Introduce coding system (3M) and

instructions

*STAGE III- Actual teaching of ICD-10

*STAGE IV- Practice coding sessions for both
impatient and outpatient settings

*Training for ICD-10

*SPECIALITY TRAINING= 35-38 hours of
training in 3 stages

*STAGE I- Overview of ICD-10 coding and

training materials

*STAGE II- Introduce ICD-10 and coding

instructions

*STAGE III- Teach the instructions for coding

different specialty settings

*Readiness Assessment
* There is a coder readiness assessment exam
given at the end of training

* 100 question exam, identifies individual

strengths and weaknesses

* All coders must take an ICD-10 Proficiency

Assessment

* 75 question exam, open book, and must be

passed in no more than 2 attempts over the 2

year training period.

*Additional Training
* 3M created a program

consisting of 22 modules in
90min sessions
* Includes an overview of ICD10, with self assessments
* Focuses on medical
terminology, physiology,
pharmacology, anatomy, and
pathophysiology depending on
job functions
* Training videos are available
if needed

* The World Health

Organization created a
program consisting on 22
chapters

* Includes an overview of ICD10, instructs coding by body

system

* Covers certifications,

confidentiality, ethics, data

quality, rules, and guidelines
for morbidity and mortality
coding

*Motivation
* To keep staff motivated there will be a

newsletter and announcements for each stage

of training

* All employees are then aware of the training

process, and the different materials offered

* We will be giving Continuing Education Credits

(CECs) to all clinical and coding staff that

demonstrates their knowledge and skills of ICD10

*References
http://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD1
0SmallandMediumPractices508.pdf
http://journal.ahima.org/2012/10/01/case-study-computerassisted-coding-increases-productivity/
http://solutions.3m.com/wps/portal/3M/en_US/HealthInformation-Systems/HIS/Products-and-Services/Products-ListA-Z/360EncompassSystem/
http://library.ahima.org/xpedio/groups/public/documents/ahi
ma/bok1_047258.hcsp?dDocName=bok1_047258
http://static.aapc.com/ppdf/AAPCICD10Roadmap2014B1.pdf
http://www.ahima.org/downloads/pdfs/DistanceEd/RoadMap_
011712.pdf

*References, cont.
http://multimedia.3m.com/mws/mediawebserver?mwsId=S
SSSSufSevTsZxtUoxme4Y_UevUqevTSevTSevTSeSSSSSS-&fn=cs_educ_program_fs.pdf
http://news.3m.com/press-release/company/3mintroduces-icd-10-physician-education
http://journal.ahima.org/icdsummit/2011/04/tips-forsuccessful-training-2/
http://www.ahima.org/ContinuingEd/Campus/courseinfo/I
CD10.aspx
http://www.himss.org/content/files/ICD10Budgeting20091119.pdf