Training for ICD-10: 3 Approaches

February 13, 2015

When preparing to train practice staff, consider whether they need awareness, intense, or extensive instruction.

U.S. physician practices are anticipating the implementation date for ICD-10 on Oct. 1, 2015. One area most practices are thinking about and planning for is educating their staff.

In order to facilitate training, an ICD-10 training plan should be developed to ensure that all the educational needs of the practice are met. Identifying a physician champion or ICD-10 expert for the practice will assist with the initial and any future training needs of the office. The selected individual may not be an employee of the physician practice but could be the ICD-10 expert at an affiliated hospital, another local medical practice, or even a consultant. This expert should be trained on all aspects of ICD-10 including the general equivalence mappings (GEMs) - what GEMs are, and understanding why GEMs are not a substitute for appropriate coding, but should be utilized only as a mapping tool between ICD-10 and ICD-9.

Once an expert is chosen, a detailed training plan should be developed. Start by deciding which employees need training, what type of training each will need to continue to effectively do their jobs after the ICD-10 implementation, and when the training should occur. Each staff member of the practice should have, at the very least, a basic understanding of what ICD-10 entails. This role-based training model can be separated into three different levels: awareness, intense, and extensive.

AWARENESS TRAINING

All individuals in a practice setting need at least awareness training regardless of their job responsibilities. Examples of roles that may need only basic ICD-10 training are office managers, schedulers, and non-clinical personnel. These individuals should be able to understand what the transition is and how it will impact the practice, as well as implications it may have to their own work flow.

Awareness training should start within three months to six months of the date of ICD-10 implementation. It could be a single session or multiple sessions. One way to ensure that all staff members get this level of training is to engage the employees with small doses of what they need to know throughout the next few months. For example, one expert found that utilizing ICD-10 tidbit e-mails went a long way with his staff in generating understanding. It didn't take but a few minutes to read the information provided each week. As a way to gauge the retention rate of the employees, they were asked to complete a 10-minute survey each month that related to the information that was previously received and reviewed. If retention problems were noted, the expert could go back to a certain topic and go more in depth with the training. Another expert decided that a 15-minute presentation at bi-weekly staff meetings was the route for awareness training of those employees. Verbal communication of these key areas was used to ensure the individual understood these aspects of ICD-10.

INTENSE TRAINING

Intense training will be needed for providers, clinicians, ancillary staff, quality managers, and compliance officers; the majority of those at a practice. The following are some roles that fall into the intense training category: physicians, PAs, NPs, registered nurses, licensed practical nurses, medical assistants, imaging or laboratory managers, and individuals who are responsible for the quality management and compliance for the practice.

Employees that need intense training should experience the same training for ICD-10 awareness but would additionally need to have targeted training based on the practices' top 20 billed diagnosis codes. The exact number of diagnoses would be determined by each practice. Shorter training sessions for this group will be better received than perhaps a full day of learning. Make the training relevant to these individuals specifically. The list below contains main points that should be communicated during this training.

• Fundamentals of ICD-10;

• Differences between ICD-9 and ICD-10; and

• Code structure and conventions review.

These individuals should be trained at least six months to nine months prior to Oct. 1, 2015. Some of the areas will need to be reviewed again at different intervals in order to retain the information and changes between the two code sets.

EXTENSIVE TRAINING

Any practice employee whose role includes assigning ICD-9 codes for ordering tests, reimbursement, or quality initiatives will need to undergo an extensive ICD-10 training process. A gap analysis of these individuals will provide the current skill level and what each of them will need to obtain ICD-10 proficiency. Additionally, this category of learners should be assessed before ICD-10 training is started to find out which individuals should brush up on their skills in anatomy and physiology or pathophysiology, as needed. The American Health Information Management Association (AHIMA) estimates that approximately 16 hours of hands-on coding training in ICD-10 will be needed in order for an individual to learn the new code set. These employees must be trained on all aspects of coding with ICD-10. Those include the areas listed in the awareness and intense training categories as well as the following:

• Working foundational knowledge of the biomedical sciences;

• Understanding how to utilize all resources available to ensure continued accuracy of coded data;

• Identifying the differences between ICD-9 and ICD-10 coding guidelines, and being able to utilize those when applying ICD-10 codes; and

• Ensuring accurate and compliant coding with ICD-10 codes on claims.

ICD-10 training should begin as soon as the employees have been assessed. Detailed education in the new code set should have already started within the last six months leading up to the ICD-10 transition, for these staff members to become experts. Weekly practice on "real" cases ensures that the coding staff will be able to correctly assign the appropriate claims to the bill at ICD-10 implementation, which decreases the chances of any delay in payment. These practice exercises should include both code sets. This is referred to as dual coding in which both the ICD-9 and ICD-10 diagnosis codes are assigned for internal education purposes.

TRAINING SOLUTIONS

CMS, the AMA, and AHIMA offer free and paid resources for the transition and implementation of ICD-10. CMS's "Road to 10" (bit.ly/Road-to-10) is a library of free online resources for providers of small practices. The AMA provides informative resources for its members but has a section of free downloadable items for nonmembers (bit.ly/AMA-ICD10). AHIMA provides a multitude of free resources to nonmembers (bit.ly/ICD10-AHIMA) as well as a members' only area. One single solution will not work for every physician practice. It is imperative to quickly figure out which solution works for each practice.

Angie Comfort, RHIA, CDIP, CCS, is a senior director of health information management practice excellence at AHIMA. E-mail her at angie.comfort@ahima.org.

© 2015 American Health Information Management Association (AHIMA). Reprinted by permission.

This article originally appeared in the February 2015 issue of Physicians Practice.