Home Health & Hospice Week

Here's what to expect for staff training

ICD-10 is a hot topic for home care providers, and like it or not, the implementation date is currently set for less than three years away.

While there's still more groundwork to lay, it's not too early to start implementation planning and preparation -- and to take advantage of the lead time, says Sue Bowman, director of coding policy and compliance with American Health Informa-tion Management Association, which has endorsed the ICD-10 timeframe proposed by the Centers for Medicare & Medicaid Services (see related story, p. 346). Below are some key differences between the two systems:

• More specificity. Level of detail and specifics are greatly expanded in ICD-10-CM. But while ICD-10 can provide greater specificity, it won't require more detailed documentation. Other initiatives such as pay-for-performance and quality measures will require more detailed documentation, Bowman says. ICD-10 will simply provide the means for reporting it.

• Newer terminology. ICD-10-CM updates medical terminology and classification of disease to be consistent with medical practice.

• More details. With ICD-10, clinicians and coders can provide more detail with a single code than they can in ICD-9.

Added detail makes ICD-10-CM more applicable to non-hospital health care encounters -- a plus for coders in home health. ICD-10-CM also adds the ability to describe laterality (affected side of the body), particularly in the injury chapter.

• More characters. Codes in ICD-10-CM are all alphanumeric and can be up to seven characters in length. The seventh character, referred to as an extension, is used in some chapters to capture episode of care and other additional information.

• More combination codes. ICD-10 combination codes provide detail that requires more than one code in ICD-9.

For example: In ICD-9-CM, for a patient with type II diabetes and diabetic retinopathy, you would code 250.50 (Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled) and 362.01 (Background diabetic ret-inopathy). In ICD-10-CM, there is a single code for each type of diabetes with each possible complication, so you would use a code like E11.31 (Type 2 diabetes mellitus with diabetic background retinopathy).

Obviously clinicians and providers will want to get some official training. But don't get your staff trained too far in advance, warns Joanne Byron, CEO of the American Institute of Health-care Compliance, in an e-mail to members. If staff can't apply what they've learned, the "use it or lose it" factor will kick in.

Best bet: Wait until three to six months before the final implementation date, Bowman suggests. Two to three days of training should be adequate for trained ICD-9 coders to learn what they need to know to make the transition, she estimates. Training could become quite expensive, but you can avoid unnecessary retraining costs by training one or two key people and having them train the rest of your staff, Byron suggests. Also, "secure a line of credit and financially plan in advance to cover expenses for the last quarter of the year of implementation of ICD-10."

Good idea: Change necessary coding forms as soon as your staff has completed their training, Byron says. "This will allow them to use what they have learned and reinforce their understanding of the new code sets."

Finally, "upload the new codes at least one month in advance, but use software security to prevent the codes from being assigned to dates of service prior to the effective date," Byron says.

Some help: CMS hosted a series of conference calls this fall that covered the ways in which ICD-10 will differ from the current ICD-9 system.The transcript for non-hospital, non-physician providers is at http://www.cms.hhs.gov/icd10/Downloads/Nov12calltranscript.pdf.

Other education resources, like fact sheets, an ICD-10 overview, and code tables and descriptions are available through links on CMS's main ICD-10 page at www.cms.hhs.gov/ICD10. You can view the ICD-10 codes at www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm.