Key points are presented for effective ICD-10 education and training to help ensure the smoothest transition possible.

1. Organization-wide ICD-10 CM/PCS Training
VHA ICD-10 Webinar Series
1

2. Organization-wide ICD-10 CM/PCS Training
Presented by:
Kathy M. Johnson
CARE VP Quality & Compliance
Julie Daube
CARE Coding Quality Review & Education Manager
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3. Organization-wide ICD-10 CM/PCS Training
2013
2013
Multi-Year 2012
2012
Budget
2011
2011
Leadership
Team
Readiness
Gap
Assessment
Analysis
Communication
Plan
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4. Organization-wide ICD-10 CM/PCS Training
ICD-10 Project Manager Requirements:
This project will have very high visibility Strong background in project
and will impact significant management in a healthcare
expenditures. information and technology
environment
The ICD-10 Project Manager role has
Demonstrated successful leadership
three major attributes: and management experience with
project management skills, supervisory responsibilities.
people skills, and Confident with ones abilities to make
domain knowledge in health care correct decisions and the courage to
speak out when necessary.
information, coding classification
systems and related work Willingness and ability to effectively
engage with people and organizations/
processes (ICD9 & ICD10).
vendors on a continuous basis.
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5. Revenue Cycle Impacts
Patient Access Services Charge/Coding Integrity Patient Financial Services
Scheduli Charge Claims
Capture Processi
ng Entry ng
Pre-
Registra Account
Registra tion
tion Resoluti
Financia on
l Coding
Assignme Pricing
Counseli nt Payment
ng Posting
Test Clinical
Interven
Order tion
“Optiona
l” Clinical
Doc.
Schedulin HIS Claims
(includin HIM Clearinghou
g g
CPOE) se
Patient
Accountin
g
Utilization Case Patient
Management Management Accounting
Performance
Measurement
Medium Impact to process Large impact to process
and training and training
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6. Multi-year ICD-10 CM/PCS Training Budget
Absolutely All
Revisit ICD-10 CM/PCS
Revise Implementation
Rejuvenate Phases
Allow
All
For Contingency
Departments
Plans
Engaged
Allocate
Internal
And
External
Resources
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7. Organization-wide ICD-10 CM/PCS Training
Assign responsibility for development and
orchestrating the organization-wide training
Engage key stakeholders in oversight and
removing obstacles
Anticipate the impact training will have on
productivity and workflow
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8. Organization-wide ICD-10 CM/PCS Training
Group I
Group V Group II
ICD-10
Training
Group IV Group III
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9. Organization-wide ICD-10 CM/PCS Training
ICD-10
Training
Group I
Awareness
Group I Familiar with general
focus
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10. Organization-wide ICD-10 CM/PCS Training
Group I
Group II
ICD-10
Moderate
Training
understanding of
– ICD-10 CM
– ICD-10 PCS
Group II
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11. Organization-wide ICD-10 CM/PCS Training
Group I
Group III
Detailed understanding
ICD-10
Training ICD-10 CM
Group III Group II
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12. Organization-wide ICD-10 CM/PCS Training
Group I
Group IV
ICD-10
Group IV
Training
Group II Detailed understanding
– ICD-10 CM
– ICD-10 PCS
Group III
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13. Organization-wide ICD-10 CM/PCS Training
Group I
Group V
Group V Group II
ICD-10
Training Power user for
– ICD-10 CM
– ICD-10 PCS
Group IV Group III
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14. Physician ICD-10 CM/PCS Training
Group I
Group V Group II
ICD-10
Training
Group IV Group III
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15. Physician ICD-10 CM/PCS Training
Group II Group III Group IV
Moderate Detailed understanding Detailed understanding
understanding CM & CM only of CM & PCS
PCS
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16. An Inventory for Organization-wide ICD-10
CM/PCS Training
Position Title or Role Number Learning
of Staff Group
Hospital Inpatient Coder 16
Case Management Staff 12
Clinic Coder 28
Nursing Practice Leadership 6
IT Systems Analyst 7
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17. Timeline for Organization-wide ICD-10
CM/PCS Training
Year 2010 2011 2012 2013
Phase I Impact Assessment
Phase II Preparing for Implementation
Phase
Go Live
III
Preparation
Phase IV Post –
Implementation
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18. Organization-wide ICD-10 CM/PCS Training
Outline by Learning Group
Phase Objective Design Modality Resource
I awareness, gain inform, one staff in-house
familiarity way design meetings
II understand interactive webinar & CARE
follow-up
III apply hands on use workshop CARE
in-house
power user
IV maintain, interactive 1:1 mentor, CARE
advance helpline in- house
power user
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19. Organization-wide ICD-10 CM/PCS Training
Highland Facility County Facility Main St.
Facility O Center K Clinic
Task Begin End # Coders Responsible
Pre-Test All coders, IP and OP
All coders take online assessment 2/21/11 2/25/11 CARE
Workshop I - ICD-10 Introduction 2.5 hour sessions All coders, IP and OP
(AM & PM
each day)
Session 1 (AM) OP 03/15/2011 1-3:30 3/15/11 8 CARE I
Session 1 (PM) IP/OP 03/15/2011 1-3 3/18/11 20 CARE II
Power User
Session 2 (PM) IP/OP 03/15/2011 3-5 3/18/11 20 CARE II
Power User
Session 1 (AM) IP/OP 03/16/11 8-10:30 3/16/11 20 CARE I
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20. Organization-wide ICD-10 CM/PCS Training
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21. Organization-wide ICD-10 CM/PCS Training
Scheduled Variety
Steady Appropriate (relevant)
Proportioned Balanced
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22. Organization-wide ICD-10 CM/PCS Training
Lecture
5%
Reading
10%
Audiovisual
20%
Demonstration
30%
Discussion Group
50%
Practice by Doing
75%
Teaching Others
90%
Average Learning Retention Rate
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23. Organization-wide ICD-10 CM/PCS Training
Are you using an effective instructor to deliver
training for each of the learning groups?
Are you answering the question "what's in it for me
(WIIFM)“ for each learning group?
Are you re-enforcing key information over time?
Are you creating opportunities for two-way
communication?
Are you finding effective, varied modalities or
approaches to reach your audience?
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24. Organization-wide ICD-10 CM/PCS Training
Adult Learner Characteristics
Problem-centered, seek solutions
Results-oriented, have specific results in mind
Self-directed, not dependent on others
Often skeptical about new information
Prefer to try it out before accepting it
Must relate or apply directly to perceived needs
Timely and appropriate for their current lives
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25. Physician ICD-10 CM/PCS Training
Consideration:
Must relate or apply directly to perceived needs
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26. Physician ICD-10 CM/PCS Training
ICD-10 Myths and Facts
ICD-10-CM super bills will be too long or too complex to be of much use.
FACT
Practices may continue to create super bills that contain the most common diagnosis codes
used in their practice.
ICD-10-CM based super bills will not necessarily be longer or more complex than ICD-9-
CM based super bills.
Neither currently used super bills nor ICD-10-CM based super bills provide all possible
code options for many conditions.
The super bill conversion process includes:
– Conducting a review that includes removing rarely used codes; and
– Cross walking common codes from ICD-9-CM to ICD-10-CM, which can be accomplished by looking
up codes in the ICD-10-CM code book or using the General Equivalence Mappings (GEM).
Source: www.cms.gov/ICD10/Downloads/ICD-10MythsandFacts.pdf
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27. Physician ICD-10 CM/PCS Training
ICD-9 Digestive System ICD-10 Digestive System
578.1 Blood in stool K92.1 Melena
564.00 Constipation, unspecified K59.00 Constipation, unspecified
562.10 Diverticulosis of colon K57.30 Diverticulosis of large intestine without
562.11 Diverticulitis of colon, NOS perforation or abscess without bleeding
535.50 Gastritis, unspecified, w/o hemorrhage K57.50 Diverticulosis of both small and large
558.9 Gastroenteritis, noninfectious, unspecified intestine without perforation or abscess without bleeding
530.81 Gastroesophageal reflux, no esophagitis K57.90 Diverticulosis of intestine, part unspecified, without
455.6 Hemorrhoids, NOS perforation or abscess without bleeding
564.1 Irritable bowel syndrome K57.20 Diverticulitis of large intestine with perforation and abscess without
bleeding
K57.40 Diverticulitis of both small and large intestine with perforation and
Total Codes: 9 abscess without bleeding
K57.52 Diverticulitis of both small and large intestine without perforation or
abscess without bleeding
K57.80 Diverticulitis of intestine, part unspecified, with perforation and
abscess without bleeding
K57.92 Diverticulitis of intestine, part unspecified, without perforation or
abscess without bleeding
K29.70 Gastritis, unspecified, without bleeding
K29.90 Gastroduodenitis, unspecified, without bleeding
K52.8 Other specified noninfective gastroenteritis and colitis
K52.9 Noninfective gastroenteritis and colitis, unspecified
K21.9 Gastro-esophageal reflux disease without esophagitis
I84.20 Unspecified hemorrhoids without complication
K58.0 Irritable bowel syndrome with diarrhea
K58.9 Irritable bowel syndrome without diarrhea
Total Codes: 18
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28. Organization-wide ICD-10 CM/PCS Training
http://www.aafp.org/fpm/20060900/43inse.html
ICD-9 and ICD-10 Templates
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29. Organization-wide ICD-10 CM/PCS Training
ICD-9-CM ICD-10-CM
Small bowel obstruction due Small bowel obstruction due
to exacerbation of Crohn's to exacerbation of Crohn’s
disease of the small disease of the small
intestine intestine
555.0 + 560.89 K50.012
Enteritis regional small
intestine , with complication
including obstruction
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30. Organization-wide ICD-10CM/PCS Training
Clinical Documentation
Improvement
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31. Organization-wide ICD-10 CM/PCS Training
Arteriosclerotic heart disease (ICD-
10 CM diagnosis code I25.10)
Congestive heart failure (ICD-10
CM diagnosis codes I50.20–I50.9)
Cardiac arrhythmias (ICD-10 CM
diagnosis codes I49.8 and R00.1)
Coronary bypass grafting (ICD-10
PCS procedure code table 021)
Cardiac catheterization (ICD-10
PCS code table 4A0)
Percutaneous transluminal
angioplasty (ICD-10 PCS code
table 027)
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32. Organization-wide ICD-10 CM/PCS Training
Using General Equivalency Mapping
Write training material for ICD-10 coding education
Develop document improvement program for ICD-10 documentation needs
Mine the GEM to understand the translation challenges in clinical/coding
areas of particular interest to you
41000 Acute myocardial infarction of anterolateral wall, episode of care unspecified
To I2109 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
41001 Acute myocardial infarction of anterolateral wall, initial episode of care
To I2109 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
41002 Acute myocardial infarction of anterolateral wall, subsequent episode of care
To I2109 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
41010 Acute myocardial infarction of other anterior wall, episode of care unspecified
To I2109 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
41011 Acute myocardial infarction of other anterior wall, initial episode of care
To I2109 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
41012 Acute myocardial infarction of other anterior wall, subsequent episode of care
To I2109 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
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33. Organization-wide ICD-10 CM/PCS Training
Which GEM to use?
I-10 to I-9 GEM
– Conversion of application logic containing code lists
I-9 to I-10 GEM
– Research and forecasting of issues
Both I-10 to I-9 AND I-9 to I-10 GEM
– Small conversion projects with access to clinical detail
beyond the codes
– General education
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34. Organization-wide ICD-10 CM/PCS Training
GEM Use - Replication versus Optimization
The goal of replication is to produce an I-10 based
application that produces essentially the same results as the
current I-9 based application
– Translations must be reviewed and finalized, this is not
automatic
– MS-DRG conversion is an example of replication
The goal of optimization is to produce an I-10 based
application that produces optimized results based on the
increased detail in I-10
– Much more complex task
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35. Organization-wide ICD-10 CM/PCS Training
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36. Organization-wide ICD-10 CM/PCS Training
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37. Organization-wide ICD-10 CM/PCS Training
Consider the Numbers:
– ICD-10 CM: 16 hours of structured training
– ICD-10 PCS: 24 hours of structured training
– Building Proficiency: 500 - 1,000 hours
– Managing Current Workload While Learning New
Priceless!!
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38. Organization-wide ICD-10 CM/PCS Training
Example is not the main thing
in influencing others,
it’s the only thing.
Albert Schweitzer
French Philosopher, Physician, Missionary
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39. Organization-wide ICD-10 CM/PCS Training
Ask Me
About
ICD-10
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40. Organization-wide ICD-10 CM/PCS Training
Email: Email:
kjohnson@care-communications.com jdaube@care-communications.com
Telephone: Telephone:
1-312-229-7167 1-312-229-7173
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