Dual coding is probably the best idea to support the ICD-10 transition that many healthcare providers may not be able to afford. Here's why.
First, providers must have the healthcare IT systems that support ICD-10 codes. Ideally the system supports the ICD-9-CM code set at the same time. That already is in your budget. But in order to start assigning ICD-10 codes, those systems needed to have been 2013 purchases, not 2014 budget items.
And of course, medical coders need to be trained in ICD-10 coding. But coders aren't the only training need. Clinicians need to be trained on documenting the correct level of specificity to support ICD-10 coding. Otherwise, dual coding will be a waste of time.
While dual coding is a good chance to test documentation and how much medical coders know, it becomes more valuable if the process isn't bogged down in basic mistakes that could be addressed first in awareness campaigns. It's best to use dual coding to locate unforeseen problems. This requires the investment of time and money before dual coding can begin.
ICD-10 tests are showing a 50 percent drop in medical coding productivity. That means in the time that medical coders are assigning ICD-10 codes to two medical claims, they NOT processing four medical claims for real reimbursement. And don't forget the time spent querying clinicians for medical details. This is time taken away from preparing ICD-9 claims.
Of course extra medical coders can be hired to cover the dual coders. Healthcare providers need to do a cost-benefit analysis to determine if it's better to hire personnel or accept longer reimbursement cycles.
While we're considering medical coding productivity, think about accuracy. How do medical coders know they have assigned the proper ICD-10 codes? They're doing it for the first time.
The Hospital of the University of Pennsylvania (HOP) has a roundtable of ICD-10 superusers to help gauge coding accuracy. Each member tackles the same records. If there is any variance, the roundtable discusses why and comes to consensus on the correct ICD-10 codes needed.
That sounds great. But it just adds more time to the dual coding process. Maybe it's a necessary cost that prevents costly problems after Oct. 1. If so, healthcare providers need to budget for more time in dual coding.
Once all these costs are added up, it may be worth the investment to give medical coders a chance to practice ICD-10 coding and clinicians a chance to improve documentation. And the healthcare providers will have real case records to test with clearinghouses and healthcare payers. Not to mention how much it will tell providers about their HIT resources.
And, of course, there will be the much vaunted ICD-10 data. What will healthcare providers do with it?
First, they can analyze it to add to internal medical research. Then there is the financial impact. The test data can be used to predict DRG shifts and reimbursements after Oct. 1. Hopefully the healthcare information (HIM) department has someone on staff to do that. Otherwise, consultants will need to be hired. Even so, someone will have to invest time in analyzing dual coding data. Hopefully it's in the budget.
Chances are that all this time and money will be investments that pay off after Oct. 1. But no one will know that unless they assess the costs of dual coding now.