Dual Coding for ICD-10 Prep: Worth the Work?

The following is a guest post by Karen M. Karban, Director of Coding Integrity at H.I.M. ON CALL.
Karen Karban
At the recent AHIMA ICD-10 and CAC Summit, virtually every speaker discussed the need to begin dual coding prior to the October 1, 2014 implementation of ICD-10. Dual coding is the clinical process of coding and billing of encounters in both ICD-9 and ICD-10. It is one of the top four steps in preparing for ICD-10.

However, with clinical coders already in short supply, dual coding places additional demands on budget, staffing and workflow. So before your organization hires more coders and spends more money to dual-code, it’s important to take a closer look at the supporting rationale.

For Practices and Groups: Probably Not

For physician practices and medical groups, dual coding is probably not worth the work. Most practices treat only a few specific diseases, so the number of new ICD-10 codes and impact on revenue is limited. Furthermore, super bills and EMR templates are used to automatically code office visits. While physician practices and medical groups must certainly update these tools for ICD-10—as well as train staffs and educate physicians on new documentation requirements—the actual dual coding of office visits is probably cost-prohibitive. Dual coding in hospitals, however, is a completely different story.

 For Hospitals: Absolutely

In the hospital setting, dual coding generates solid, comparative data for forecasting and preparing prior to going live with ICD-10. It delivers three  key benefits and is absolutely necessary, even up to one year prior to the October 1, 2014 deadline.

  • Benchmarks financial impact and DRG shifts. Hospitals identify revenue winners and losers under ICD-10.
  • Assesses actual coder productivity and CDI specialist workloads in ICD-10. Hospitals calculate staffing requirements for operational budgeting.
  • Identifies gaps in clinical documentation that must be reinforced prior to 2014. Hospitals target physician education, fine-tune CDI specialist activities and update medical staff queries to improve documentation ahead of the ICD-10 deadline.

Dual coding helps hospitals prepare for ICD-10 and mitigate their risk of denied claims under the new coding system. Dual coding is also the first step in end-to-end testing for ICD-10, which is another key task to start this year, according to speakers at the HIMSS 2013 ICD-10 Symposium.

Beyond 2014

I don’t expect dual coding to continue past October 2014. However, providers will need to maintain a few ICD-9 skilled coders and CDI specialists. RAC audits and other retrospective reviews carry multi-year look-back periods, a few payers may not transition to ICD-10, and quality analysis and reporting will encompass both systems.

Although dual coding is a new concept for many of us, it is fast becoming common practice for most of us.

Karen M. Karban is the Director of Coding Integrity at H.I.M. ON CALL where she leads all coding initiatives.She can be reached at: Karen.karban@himoncall.com.  Prior to joining H.I.M. ON CALL in 2012, she served as Director of Operations, HIM Services at M*Modal; as Healthcare Consultant at Craneware, Inc.; and as Chief of Operations – Chargemaster Services at Healthcare Concepts.  Ms. Karban’s experience includes Medical Staff quality assurance, state survey corrective action plans, coding compliance plans and operational workflow redesign of coding departments. She spearheaded the Ambulatory Coding Lunch and Learn™ and is a founding contributor to JustCoding.com™.  Ms. Karban remains active as a member of AHIMA. She is a past program chair of CHIMA and AZHIMA. She holds multiple certifications through AHIMA including RHIT, ICD-10-CM/PCS Trainer and Coordinator, and Certified Coding Specialist.