Dual coding is nearly at its end for home health!

With only 14 days of dual coding left, you can feel the excitement building in the home health industry. Why, you ask? As professional coders, we are beginning to see the light at the end of the tunnel!  We knew it would take longer to find and choose codes in ICD-10, but looking up both ICD-9 and ICD-10 codes for 100% of cases has taken its toll across the country. Decreases in productivity, increases in the amount of time it takes to review one case, and increases in time spent obtaining additional documentation from providers are just a few examples of the struggles being felt nationwide.

Studies from previous countries that have implemented ICD-10 coding indicated an overall 30% decrease in productivity for professional coders during the first year. In my research, it doesn’t appear that this time loss took into account dual-coding charts in both ICD-9 and ICD-10. This means that in the United States over the past two months, the anticipated 30% reduction actually increased, causing much frustration and discouragement.

While we have been using ICD-9 for 30+ years, there are still times in the professional coder’s work day that we are unsure of the appropriate code, so additional time is spent seeking the correct codes in the first code set before moving on to the second. Coupled with the unfamiliarity of the new code set, the time it takes to perform one complete review nearly doubles. There are several tools coders can use to assist in reducing the overall time it takes to look up codes, such as General Equivalency Mapping tools (GEMs). While these GEMs can be helpful in some instances, the most widely accepted practice is simply looking up known terms in the Alphabetic Index of the ICD-10-CM coding manual. There have been so many changes and updates to codes, categories, moving of codes to new chapters, changes to terminology, etc., that relying strictly on the GEMs, or other tools, could result in lost revenue starting October 1 because of an incorrect (or a non-specific) code.

Moving on to the final discussion topic today: the increased time spent obtaining the additional documentation needed to select appropriate codes in ICD-10. With hospitals, nursing homes, physician’s offices, and other acute care settings not required to begin ICD-10 coding until October 1, much of the documentation needed for code specificity selection is still not being included in initial home health care orders and referrals. What this means to home health coders is that more cases are returned to the referring physicians for additional information, causing a greater delay. What can be done to alleviate this issue? Create a referral document to supply to the physician’s office, hospital, etc., which will inform them of exactly what documentation is required for specific diagnoses.

Home health agencies and coders are looking forward to October 1, 2015 and an end to the dual coding requirement. We predict increased productivity times, decreased review times, and with other health care entities beginning their requirement to code in ICD-10 we anticipate that referral documentation improvement. The end result will be less frustration and increased morale nationwide.

Until next time…

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