Ensuring that the coding workforce is adequately trained is central to any hospital’s plan to maintain adequate coding productivity after the ICD-10 transition.

AHIMA recommends that hospitals dedicate at least 50 hours for inpatient coder training.

This recommendation includes:

• 16 hours of training on ICD-10-CM
• 24 hours on ICD-10-PCS
• 10 hours on additional practice

Note that these estimates assume that coders have existing knowledge of anatomy, physiology, pathophysiol­ogy, pharmacology, and medical terminology to correctly apply codes using ICD-10-CM and ICD-10-PCS.

Unfortunately, many hospitals are finding that even their best trained coders have not worked with some of the background concepts in the detail required for ICD-10 since their formal coding training. To mitigate this, these hospitals are including refresher courses in these areas – typically an additional 12 – 24 hours of background review prior to beginning formal ICD-10 training efforts. This total of 75 hours is consistent with a number of other recommendations and vendor training programs we’ve reviewed, and would provide a good basis for beginning your coder training plan.

Formal Training

There are a number of approaches that a hospital can take to train coders.

These include:

• Hiring a trainer to provide formal classroom training. Instructor-led training tends to provide a very productive training environment, because of the interactive nature of the training. The key disadvantage is that once the trainer leaves, the hospital lacks resources to train additional coders, or to get coding questions answered as coders begin to practice coding in ICD-10.
• Using an online coder training program. Many hospitals have chosen to use online training programs, as they offer significant flexibility – coders can train on separate schedules, and thus avoid the impact of all the coders being unavailable at the same time for classroom training.
• Hiring or training a dedicated ICD-10 trainer. For departments that are large enough to dedicate resources, hiring or developing a dedicated trainer represents the most flexible option, as multiple coding sessions can be offered to break up the impact on the staff, and the trainer remains as a dedicated resource to work with the staff.

Many hospitals are choosing a blended approach, using combinations of one or more of these methods to best suit the needs of their workforces.

Practice Coding

To ensure that coders are ready to code productively, hospitals should ensure that coders have adequate opportunities to practice ICD-10 coding before the transition date. Many hospitals are going well beyond the ten hours recommended by AHIMA when planning practice coding.

There are many approaches to practice coding. 

• Some hospitals have chosen a formal dual-coding strategy where some portion of each day’s charts is coded in both ICD-9 and ICD-10. This has the advantage of minimizing the coder’s time per chart, because they are already familiar with the contents after the ICD-9 coding, but requires significant oversight by a trainer / quality analyst to ensure that the ICD-10 coding is correct.
• Others are choosing specific charts to be coded by all coders. This decreases the number of charts that have to be coded in ICD-10 to serve as the answer key for quality measurements, and provides more realistic time estimates of actual ICD-10 coding.
• Still others are using practice charts provided by their coder training vendor. This will probably prove to be the easiest process to manage, although using unfamiliar charts will provide an additional barrier to the coder’s timely and correct coding.

By using practice coding as a key part of a training strategy, hospitals can improve coders’ quality, productivity, and confidence.  Gaining practice in advance of the transition date, provides coders additional familiarity with the new coding requirements. This will decrease the temporary coding impact described in the “Impact of ICD-10 on Coding Productivity” post.

Many hospitals estimate that the costs of practice coding before the transition date will speed their coders progress from the 50 percent initial productivity decrease to the 20 percent permanent loss. They anticipate that this will offset some of the costs of the practice coding program, particularly where expensive contracted resources are used to make up for the productivity drop.

Whatever combination of training solutions you choose, hospitals must be aware that having a fully trained workforce will not allow them to completely avoid productivity impacts.

This post was originally published on January 14, 2014 and republished in light of the new ICD-10 /2015 deadline.