The U.S. Department of Health and Human Services (DHHS) has called for the replacement of ICD-9-CM code sets with ICD-10 code sets, effective Oct. 1, 2013. The time for education and training is now. But health care organizations (HCOs) must first identify the foundational knowledge required for ICD-10-CM and ICD-10-PCS use, pinpoint coders' training needs and develop a complete ICD-10 educational plan.

DHHS has already increased the number of training hours needed by inpatient coders from 40 to 50, while increasing outpatient coders' training hours from 8 to 10 (http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf). Meanwhile, the American Health Information Association (AHIMA) has identified coder skills and competencies - from mastery of biomedical sciences and application of codes, to inpatient encounters and creating maps and crosswalks between ICD-9-CM and ICD-10 systems (http://ahima.org/icd10/role.aspx).

The HCO's Role

How should HCOs respond? First, they must evaluate coders' knowledge and skill levels related to using information within the medical record, documentation requirements and guidelines, coding fundamentals and biomedical sciences, including anatomy, physiology, pathophysiology, pharmacology and medical terminology. Evaluation may take many forms. Coder assessments - testing tools that assess the knowledge and skills of coders - are helpful tools to use in conjunction with statistical analysis. HCOs that analyze current coding productivity and accuracy through efforts such as in-depth audits, and then include those results with an evaluation of top diagnoses, procedures and MS-DRGs to identify high impact or risk areas, are able to establish a baseline against which to develop educational plans and benchmark progress.

Equally important, HCOs should introduce best practices that focus on more consistent, complete use of the medical record, increased documentation scrutiny, including usability for coding and improved compliance with coding fundamentals and guidelines.

Finally, HCOs must deliver training that bolsters coders' knowledge of anatomy, physiology, pathophysiology, pharmacology, medical terminology, medical treatments and surgical procedures, along with medical record navigation skills. The latter must include location of forms, use of information sources and documentation requirements and guidelines, including acceptable terminology, abbreviations and sources and authentication.

The Coder's Role

Coders must grasp the differences between ICD-9 and ICD-10 through refresher guidance on coding conventions, rules and guidelines, organization and formatting of index and tabular listings, steps for referencing main terms in indices and finding codes in tabular lists, reading and following inclusion/exclusion notes, applying  rules related to combination codes and using additional codes and sequencing.

Also important is asking coders to master the shared rules and conventions of ICD-9 and ICD-10 and the potential roadblocks of medical terminology. That, in turn, requires an understanding of the meaning of eponyms, syndrome names, alternative names and descriptions for diseases, adjectives used to describe and define diseases and disorders and  terms used to describe surgical approaches and techniques, such as resect, dissect, incise, excise, aspirate and scope.  

Because coders must understand "normal" body functions to pinpoint abnormal ones, they need a sound knowledge of anatomy, the structure and relationship of body parts, as well as physiology, how various parts, organs and systems function within the body. But since ICD-10-CM contains combination codes that feature the underlying condition, as well as its manifestations, complications or associated conditions, coders must also understand pathophysiology or how disease processes affect the body. Especially critical for coders is knowledge of etiology, disease characteristics, signs/symptoms, manifestations, stages and progression, sequelae, prognosis, related conditions and complications.

Additionally, coders must grasp pharmacology basics - from poisons, toxins and measurements, to side effects and contradictions , as well as how to classify surgical procedures in terms of section, body system, root operation, body part, approach, device and qualifier. Coders need mastery of surgical approach, tools and techniques, procedure purposes, codes not identified by eponyms or names and standardized procedural definitions.

Education, Education, Education

ICD-10 implementation calls for ongoing education and training, which requires sound assessment and planning. Make sure your educational program helps coders understand and become more familiar with the medical record. As coders expand their health sciences knowledge, they must become familiar with the electronic health record to ensure all appropriate components of a health record are evaluated to help identify specificity for the principle diagnosis, co-morbidities and complications. Coders must increase their clinical knowledge of conditions and procedures to be able to differentiate "normal" versus "abnormal" to understand when it is appropriate to query physicians for more specificity.

Education for ICD-10 implementation is a journey, not a destination. Short-term or one-shot training solutions can never work. Urgent action is needed. While ICD-10 experts have recommend that HCOs launch coder education programs 1 year before implementation, a growing body of research calls on HCOs to take immediate action to educate coders on core concepts.

To that end, HCOs should take full advantage of an array of available educational materials - from white papers, webinars and electronic implementation guides, to ICD-10 readiness assessments, comprehensive education programs in ICD-10 and clinical documentation and foundational materials related to topics such as  pathophysiology and medical terminology.

Deborah Neville is the director of revenue cycle, coding, and compliance for Elsevier/MC Strategies where she directs the writing and production of a comprehensive catalogue of online education curricula for coding, revenue cycle and compliance.