Should your organization be engaged in dual coding or double coding programs, and are you ready to begin? Two very important questions to ask as we move closer into ICD-10 implementation.
To begin with, let’s define dual vs double coding. Coders who are engaged in dual coding, also referred to as “native coding” are coding in both ICD-9-CM and ICD-10-CM/PCS for the same record. They are using each code set and all of the associated coding conventions and guidelines to code the chart – and they are coding directly from either ICD-9 CM or the ICD-10-CM/PCS. They are not using crosswalks or GEMs to assign codes. On the other hand, the term “double coding” is used to describe coding every record in both code sets; this is extremely labor intensive and cost prohibitive to begin at this late date and further, there is not data that indicates this is a better method.
What works, is a well-designed dual coding program. As you are looking for a well-designed program, you should be specifically looking for key elements such as:
- Strategic Teaching and Remediation – Education is the core to the ICD-10 transition and therefore, it should be no surprise it’s first on our list. Keeping in mind there are two key participants in the dual coding exercise, the coders and the clinicians. Education will enable the coder to practice using the newly acquired skill set in a safe environment and will help to identify and remediate deficits in documentation by your clinicians.
- Native Coding – Your coders will gain both speed and accuracy by using the new ICD-10 code set rather than constantly looking to GEM all of the codes from ICD-9 to ICD-10. There are many codes that do not have a 1:1 mapping and a significant amount which will require additional specificity and information. Another advantage for using the native coding strategy? Developing speed and accuracy will boost confidence as your coders refine their skills in the new code set and this will help mitigate the potential loss of productivity expected with the learning curve.
- Clinical Documentation Review and Assessment – One of the greatest advantages of dual coding is that it enables us to provide a detailed review and remediation of the clinical documentation provided by physicians. When organizations engage in the dual coding process, coders can strengthen their skills and locate missing documentation while simultaneously, clinicians can be alerted to the deficits of their documentation. This will also enable the organization to further develop and refine the query process.
- Database testing – Dual coding provides the detailed data which is required to initiate end-to-end testing with payers.
- Financial analysis – Although CMS has repeatedly said that the ICD-10-CM/PCS implementation will be budget neutral there will undoubtedly be challenges in the revenue cycle. Dual coding can provide the documentation and data for financial analysts needed to mitigate potential risks during and after the go-live date.
Before starting any dual coding program, there are specific prerequisites needed to build the foundation. As previously stated, staff must have engaged in an in-depth, role-based ICD-10 training program. Included in the skill set for coders must include anatomy, physiology, medical terminology and pathophysiology. Coders should have also had an opportunity to practice using the new CM and PCS code systems. In addition, your clinicians must take on the responsibility of learning the new documentation strategies required for the new code set. Clinician training should be specialty specific and offered in an asynchronous learning environment. Finally, finding a reliable clinical documentation solution (an app) is also highly recommended so the clinicians have a reference solution available even after the initial implementation and go live date.
Finally, you must work with your IT vendors to create separate databases for ICD-9 and ICD-10. Vendors must allow “native” coding in both systems as crosswalks will not work.