Overlooking Little "C" Coders Puts ICD-10 At Risk

By  Wendy Coplan-Gould, RHIA, President, HRS

Seventy-seven percent of hospitals have already initiated ICD-10 training plans for their coding staff^[i] - typically clinical coders already employed in health information management. These coders are easy to identify, group and train. They are credentialed staff whose primary role is to assign codes - and they are probably already covered in a hospital’s ICD-10 training plans.

But what about the rest of the hospital? Are other coders lurking in the halls? Hiding behind cubicles? Hanging out on nursing stations? The short answer is … yes.

Practically every department houses staff that use codes day-in and day-out. They are the ones hording worn and torn cheat sheets and outdated coding books. These are a hospital’s little “c” coders and they can’t be overlooked!

Three Steps: Find, Assess and Train Little “C” Coders 

First, FIND them. These coders are an important step in the hospital revenue cycle and ignoring them will cost the organization money, especially under ICD-10. Little “c” coders are defined as anyone who:

• Uses ICD-9 codes today in their daily work; or
• Contributes to clinical documentation.

ASSESS each and every department to identify these little “c” coders. Enlist the support of management teams to get this task completed quickly and efficiently. Here are a few of the nooks and crannies to consider:

• Patient Registration
• Central Scheduling
• Utilization Review
• Quality Improvement
• Ancillary Departments: Lab, Rad, Respiratory, Etc.
• Infection Control
• Patient Accounting
• Dietary
• And More!

Expect these coders to balk at the idea of ICD-10 education. They don’t want to be bothered with assessment and training because they believe they “don’t code.”  However, coding errors produced in these departments cost the organization money in denied claims and revenue logjams.

Finally, it is important to DEFINE and COMMUNICATE the little “c” coders’ roles in reimbursement; not only to cost-justify the next steps but to also get them on board with ICD-10.

Assess Educational Needs

Once all little “c” coders are inventoried, their educational needs must be assessed. Some little “c” coders only need to know the high-level differences between ICD-9 and ICD-10, and new coding cheat sheets. Others should be given a deeper understanding. Checklists and/or Web surveys may be the fastest and most efficient way to assess little “c” coders. With limited resources for ICD-10 implementation, many organizations employ outside consultants to conduct these ancillary assessments. 

Create an Educational Plan

Lastly, structure an educational plan for these staff that ensures minimal interference with their day-to-day work. Plans should be role-based and fine-tuned to fill in the knowledge gaps identified during the assessment phase. Staff requiring a deeper knowledge of ICD-10 should be assessed on biomedical sciences and trained-up accordingly for their specific areas of clinical care (anatomy, physiology, epidemiology, pharmacology, etc.).

Ring In 2013 with New Coding Experts

Finally, industry experts predict an initial drop in coder productivity with ICD-10. Many anticipate coders will never regain ICD-9 levels of code output.

With this in mind, growing little “c” coders into big “C” coders should be just one part of a hospital’s overall coder recruitment and retention strategy in 2013. There are many stones to uncover in the journey to ICD-10. The little “c” coders are an important one!