“I wish I had a crystal ball. What keeps me up at night is that exact question,” says Lynne Thomas Gordon, CEO of the American Health Information Management Association. How long will it take for coders to become comfortable with ICD-10, she says.
There's no shortage of candidates interested in coding jobs, Gordon says, again stressing the need for hospital experience. Many certified coding specialist job listings require candidates to have medical terminology knowledge.
One way AHIMA is attempting to help coders achieve the prerequisite experience is through an upcoming paid apprenticeship program, which will provide job candidates with a clearer career path and give them in-hospital experience.
This type of job shadowing will produce more-qualified coders, Gordon says. AHIMA and other organizations offer certifications, which make the job candidate more attractive to an employer. Coders with certifications also typically earn higher salaries.
Students can also take specialty code-set training. That could help with medical terminologies, but isn't needed. Credentials also aren't mandatory for ICD-10 work.
“It's not necessary, but it's certainly something that somebody would want to look for to show a certain level of competency,” says Stanley Nachimson, principal of IT consultancy Nachimson Advisors, based in Reisterstown, Md.
There's a substantial industry cost for the switch over to the new version of ICD. HHS projects that the changes, including the purchases of new IT systems and staff training, could cost $2.3 billion to $2.7 billion industrywide over 15 years. The cost of ICD-10 coder training alone could cost an organization from $2,405 to $46,280—depending on its size—according to Nachimson research.
Some concerns remain over the workload of veteran coders during the transition, because many will not only be responsible for their everyday work, but also for training less-experienced colleagues. While some hospitals and health systems may be well into their implementation plans, others are just getting started with training, Nachimson says.
One problem with training too ambitiously early on is the risk of staff losing key skills in the 16 months before ICD-10 is implemented. Systems such as Norfolk, Va.-based Sentara Healthcare and the Cleveland Clinic are solving that issue through dual coding. The health systems are using both ICD-10 and ICD-9 at the same time. Despite the time and budgetary constraints in hiring extra coders, hospitals can use dual coding to identify ICD-10 revenue losses and claim denials. It also lets staff members practice their ICD-10 skills before the implementation date and gives the systems a chance and to iron out any problems with less pressure.
Meanwhile, some providers, including Children's Healthcare of Atlanta, have used contract management firms to find coders. Dr. Jeffrey Linzer, associate medical director of compliance for the hospital's emergency pediatric group, says the ICD-10 transition is a major issue for physicians because most practices don't employ coders. The ICD-10 transition will cost a three-physician practice $83,290, according to research from Nachimson Advisors. That cost covers training, new staff and technology. The cost is $285,195 for a 10-physician practice and $2.7 million for a 100-physician practice, according to the research.
Changes are also necessary at the nation's medical schools, which Linzer says are not properly training physicians in ICD coding. “They have to make sure their medical documentation is appropriate and gives a clear picture of why they are seeing their patients,” Linzer says. “If we could improve physician documentation, it would make the coder's life much easier.”
Follow Ashok Selvam on Twitter: @MH_aselvam