After months, and, in some cases, years of training, coders have finally begun to code in ICD-10. However, just because ICD-10 officially went live on Oct. 1, doesn’t mean that coder training should cease. In fact, just the opposite is true.
Remedial training will be critical during the first six months post-implementation. This is the time during which mistakes and deficiencies will become more apparent. It’s also the time during which organizations will see first-hand how payers plan to process the more specific ICD-10 codes. Ongoing coder training that evolves over time commensurate with denials and new Coding Clinic references is an essential ingredient of the recipe for long-term compliance.
Following are several strategies that coding managers and directors can use to ensure ongoing coder training in ICD-10.
1. Solidify the budget. Very few hospitals have budgeted for training beyond Oct. 1. However, there’s no reason to stop training coders simply because we’ve officially made the transition. Now that organizations are operating in a live ICD-10 environment, many new issues may come to light. This is the perfect time to mitigate those problems and perform corrective actions. Managers and directors should budget for additional education (beyond what coders typically receive as part of their continuing education) until at least the end of the first quarter 2016.
2. Work with your QA staff and denial management department to develop a training strategy. Ask QA staff members to track and trend coding errors as they occur. Give priority to errors or omissions that affect the reimbursement. These errors should go directly to management and to the individual coder for immediate education. In general, coding errors or omissions should be placed into one of the following two categories:
- Those that reflect a deficit in ICD-10 knowledge (e.g., misunderstanding a new ICD-10 guideline).
- Those that reflect a general deficit in coding knowledge (e.g., overlooking a diagnosis that should have been coded).
Both categories are equally as important; however, distinguishing errors and omissions as such will help focus training more appropriately.
Once claims are submitted and processed, denial management can also provide valuable insight into coder deficiencies. However, don’t assume that a denial implies a coding error. Instead, ask these questions:
- Is the denial warranted?
- On what resources or references is the denial based?
- What is the root cause of the denial? For example, is coder education necessary? Or is it a documentation issue that requires physician attention?
Use the feedback from QA staff members and denial management to design a training strategy. Do all or most coders struggle with the same issue? Are errors isolated or part of a larger trend? Asking these questions helps determine whether individual coder training is warranted or whether group training would be more appropriate and efficient.
3. Know when to provide the training. Everyone’s time is valuable, and managers need to think about how to provide training with minimal impact on productivity that is already lower than ideal. The most efficient way to approach training is to incorporate case discussions into weekly coder meetings. For example, ask coders to code a case for the first 15–30 minutes of the meeting. Then come together for the remainder of the meeting to discuss the codes assigned. An abbreviated version of this exercise would be to simply code the operative report to ensure that the PCS code is correct. Weekly coding meetings can also be a time during which specific ICD-10 questions are posed and discussed. Coders are accustomed to carving out time for these meetings, thus the meetings don’t add an additional burden to their workload.
However, in some cases, it’s better to provide individual coder training. For example, if one coder struggles with a particular root operation, don’t spend productive time making all coders review that root operation. Instead, compile educational references and materials that the coder can study on his or her own time. These materials could include articles, specific references to the coding guidelines, or specific Coding Clinics. Reassess the coder after he or she has had a chance to review the materials.
4. Stockpile anatomy and physiology references. Not all coding education must be provided in a formal setting. Opportunities for learning must also be available on an as needed basis as coders are coding each record. This is particularly true for PCS that requires a more robust knowledge of anatomy and physiology than ever before. For example, consider a coder coding a cardiac catheterization who is unsure of the anatomy of the heart. He or she must be able to immediately access information about that procedure and the corresponding anatomy to ensure coding accuracy. HIM departments must invest in clinical resources so coders have this information at their fingertips.
5. Communicate with your outsource vendor. Presumably, your vendor has implemented a QA process and plan for remedial training. How does this process and plan compare with that of your organization? For example, the training content may be the same; however, the execution of that training may differ. Are both trainings sufficient in all areas? Is there any conflicting information? The goal is to ensure consistent coding across the board. There may also be opportunities to collaborate and share training materials between the organization and vendor.
Creating, Sustaining the Feedback Loop
All coders should be informed of each and every mistake they make. This is the only way in which coders can improve over time. However, ensure that feedback is constructive—not punitive—in nature. Coders want to do the right thing—they just need to be pointed in the right direction. Consider these tips to make ongoing coder training a positive experience:
- Ask coders what they want/need. With what diagnoses and/or procedures are they struggling? What would be most helpful now that they’re coding in a live environment?
- Always examine the effectiveness of the training. If coders continue to struggle in certain areas, might the training be insufficient?
- Remind coders of what they’re doing right. Every coder wants and needs to be reminded of his or her strengths, particularly during this time of transition and uncertainty. A few words of positive encouragement will go a long way.
About the Author
Paul Strafer is the manager of coding and education at H.I.M. ON CALL. He has a wide variety of health information experience and passion for continuing education in the evolving field of healthcare makes him a valuable asset for HIM professionals focused on training and education. At H.I.M. ON CALL, Paul works with hundreds of coders and coding managers to streamline assessment, audit, and compliance programs as well as analyze all coding performance data for continual process improvements both within the firm and in partnership with H.I.M. ON CALL client hospitals.
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