ICD-10, Dual Coding – What Now?

The delay in ICD-10 adoption has left industry leaders in a land of uncertainty. It is now a month later and the health care circuit remains abuzz with the billion dollar question:

Do we proceed with our project plan, or do we discontinue our efforts?

The answer lies somewhere in the middle. Your organization may not need your programs to move forward with the same urgency as before the delay was announced, but discontinuing your efforts entirely has the potential to negatively impact the success of your organization’s 2015 implementation. A prudent approach would take advantage of the delay and alter your project plan to allow more time for planning, preparation, testing, and dual coding. This will enable your organization to better understand the impact this transition will have on the stability of your revenue cycle. As the current delay attests, this isn’t a matter of clairvoyance—no one can accurately predict the future. It is, however, a matter of risk assessment, and of intelligently embracing the resources available to mitigate that risk. It’s about how to best prepare your organizations for this momentous conversion when it finally does arrive.

If you haven’t begun already, you must evaluate the potential effect the new classification system will have on your revenue cycle. Specifically, you must understand the impact on productivity, reimbursement, and non-specific documentation and what the implications are for your bottom line.

One of the most important and valuable tools available in undertaking this evaluation is Dual Coding. Not to be confused with double coding, this is the process by which the coder assigns both ICD-9 and ICD-10 codes simultaneously. Unfortunately, Dual Coding is something of a gray area that is often misunderstood or ignored, when in reality, the the early adoption of Dual Coding can help you to capitalize on some of the benefits to be gained from its inception. Those benefits include:

  1. Analysis of provider documentation and identification of areas of risk: This provides a clear picture of which providers require additional education, and which providers could serve as physician champions to support areas of opportunity;
  2. Assessment of ICD-10 coding quality: This enables your organization to identify the need for concurrent education;
  3. The ability to provide real time data and explicit direction to the clinical documentation improvement (CDI) staff: This awards the opportunity of one-on-one provider and disease focused educational sessions;
  4. Execution of time studies: This enables you to better prepare for your specific organizational needs through analysis of real time data and actual productivity metrics, rather than planning ICD-10 go-live support staff based on another organization’s time study;
  5. Testing claims with insurance carriers as early as their systems permit: This offers the opportunity to identify and correct claim submission errors prior go-live.

Early adopters of the Dual Coding initiative are better positioned for the transition, in that their system risks have been identified and mitigated. Coding quality has been assessed, areas of opportunity have been addressed, provider documentation deficiencies have been identified, and educational platforms have been constructed to tackle documentation insufficiencies as they arise. Most importantly, coder and provider productivity deficits have been addressed, and efficient go-live staffing modules have been created based upon the facts gathered from in-house data. This is far preferable to utilizing data from another organization, which may contain information that has been less rigorously obtained.

So, where do you begin? What’s the best approach to ensuring that your facilities are ready when the switch is flipped? Here are a few suggestions:

  1. Begin immediately. Once coder education has been completed, implement the dual coding initiative. There are many avenues to choose from, so simply pick what works best for your organization. Is it beneficial for all of your coders to dual code? If so, how many records? All of them ? A subset? A dedicated number on a weekly basis? Or, would it be best if your team was split in half and rotated dual coding on a weekly basis? Whatever method you choose, stick to the plan. Discuss challenges. What obstacles did you encounter? How accurate was the provider’s documentation? Were there any codes that you couldn’t assign because of insufficient documentation? If you have a Clinical Documentation Improvement team, include them in your discussions. Learn from each other.
  2. Dual Coding alone isn’t sufficient. Initiate Dual Coding audits to evaluate accuracy, documentation patterns, and other areas of opportunity for improvement.
  3. Use your data! Begin developing educational modules immediately. Develop process improvement programs for your staff and re-educate as necessary.
  4. Develop Software. Work with your IT team to develop an analytical software tool that will assist you with your risk assessment. Begin analyzing your information by specialty, physician, coder, MS-DRG, etc.
  5. Most importantly, practice, practice, practice. Remember, “There is no glory in practice, but without practice, there is no glory.”

Dual coding is a valuable tool to assist in mitigating the risks assosicated with ICD-10 conversion. It makes sense to use the delay to implement Dual Coding in your organization. You’ll see the benefits immediately, and when the transition date finally arrives.