South Florida Hospital News
Friday December 14, 2018

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July 2012 - Volume 9 - Issue 1




To Delay or Not to Delay ICD-10 Training?

The implementation date to ICD-10-CM/PCS has not been cancelled, just delayed. And we’re not even sure for how long. The Centers for Medicare and Medicaid Services (CMS) is in the process of making a final decision on the possible extension, with the ruling expected in July.
Many industry experts offer their thoughts on what organizations should do while we wait for more information from CMS; “Don’t wait for the Centers for Medicare & Medicaid Services (CMS) to make its decision about the implementation date for ICD-10”, advises David Sayen, a CMS regulatory director. “Even if I-10 is delayed, keep on course,” he said, and make sure things are functioning properly”. That’s the advice Sayen offers to providers and payers during this time of uncertainty.
The industry should not cease preparation for the implementation, but use this extra time wisely by spreading out the training dollars over the time extension rather than trying to train everyone over a shorter period of time. The delay of ICD-10 now gives organizations the opportunity to implement process and policy changes within their organizations so that they will be absolutely ready when ICD-10 is implemented.
3M coding authors said the following about education and training in hospital for ICD-10 PCS alone:
“Topping the list of the most important aspects of implementation is education. Four areas requiring extensive education are the HIM (Health Information Management) department, medical staff, quality management reviewers and physicians. Education for all four should include basic structure of ICD-10 PCS and the expended requirements for assigning a procedure code. Each area would approach education from a different perspective. Coders need to increase their medical knowledge, physicians need to understand the requirements for documentation, and the medical staff needs to be aware of the challenges for physicians and be supportive of processes that allow greater interaction between the coding staff and the physicians. Quality management needs to understand ICD-10 PCS and how it related to its data collection, reporting, and JCAHO requirements.”
Coders will need to 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. Coders should be trained regarding their specific role in the new ICD-10 system as soon as is practically possible. The ICD-10-PCS requires a higher level of expertise in anatomy and physiology than does the ICD-9. In fact, some coders currently working in hospitals may find this requirement particularly challenging. It is one reason hospitals should perform a comprehensive gap analysis, which in this context should include an analysis of the education levels, skills, and readiness of coders to adapt to a system change.
ICD-10 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. In addition, coders need to know how to classify surgical procedures in terms of section, body system, root operation, body part, approach, device and qualifier. Coders need a mastery level of surgical approach, tools and techniques, procedure purposes, codes not identified by eponyms or names and standardized procedural definitions.
Physicians will face the need to make documentation improvements to meet hospital and medical necessity requirements. Nurses will need a clinical level of ICD-10 training, especially as it pertains to specificity of codes and documentation required to support assignments. ICD-10 implementation will have a significant impact on the Case Management Department due its dependence on diagnosis codes. Payers are going to be forced to evaluate every process as it relates to determining medical necessity, appropriateness of care, referrals, utilization, authorization and certification.
Training for ICD-10 implementation is a journey, not a destination. It is important to continue to learn about and to prepare for the eventual ICD-10 implementation. You may think it is too early to learn about ICD-10, or that if you learn it now, you will forget it by the implementation date because you are still using ICD-9. Think back to when you first learned ICD-9-CM codes. How long did that take? The time for education and training is now; the transition to ICD-10 is an immense effort that will require training to address not just coders and applications, but also clinicians!
Judy Monestime is the VP, ICD-10 Consulting for International Alliance Solutions, national experts offering ICD-10 and coding solutions for providers. CODESMART UNIVERSITY™ is an online ICD-10 education program for coders, clinicians, and executives. She can be reached at or visit
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