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My experience at an AHIMA trainer session Part 3

During this three-day training, we learned as much as possible about this new classification system. I received a letter in the mail right before leaving for the American Health Information Management Association (AHIMA) Academy for ICD-10 trainer session in Grapevine, TX, only to find out that the learning doesn’t end after the three days!

I still have to take the “final exam” between late October and late January 2010 to demonstrate that I understand and can apply this new system to become an “AHIMA certified ICD-10 trainer.”

I was surprised that there was not a specific credential or at least a designation, even if it was just an appendage onto one of my AHIMA certifications, to notate that I had endured this training. Even the American Academy for Professional Coders designates its professional medical coding curriculum (PMCC) instructors with an “I” at the end of their credential (i.e., CPC-I).

I’m not sure how to publicize that I did this training other than to add it as a tidbit of information onto my bio. It should be identified somehow right?

It was amazing to sit through such an intensive training session. I recently taught a class in Boston, and I had to admit to my students that I was reminded of how my Boot Camp attendees feel when we cover so much material in a five-day class. I had an increased sympathy for them, having endured it myself recently. It reinforced to me how important it is to have engaging, fun, and energetic instructors — especially in an intensive learning format.

This three-day session was definitely an information-overload experience, but I feel confident that I can share this information with the masses when the need arises.

Has your coding manager or coding staff members attended any kind of ICD-10 training sessions yet? Now that I’ve shared a bit of my experience, we would love to hear what yours was like. Please post your comment here.

My experience at an AHIMA trainer session Part 2

In a recent post, I talked about my experience attending an American Health Information Management Association (AHIMA) Academy for ICD-10 trainer session. While I am excited about certain aspects of ICD-10-CM, I’m not as quick to warm up to ICD-10-PCS, which is very different from what we currently use in ICD-9-CM Volume 3.

The use of the many tables and definitions of certain procedures make this system much more applicable in a clinical sense. However, I did find myself having to continually reference definitions of the various root operations in the front of the PCS manual.

I would read a question and have to really think about whether the question was about a “change,” “replacement,” “extraction,” “extirpation,” etc.

Extirpation was my word of the day. I looked this word up in the Merriam-Webster Dictionary only to find the definition includes the following:

• To pull up by the roots
• To destroy completely
• To remove by surgery

Well, that didn’t help me much considering some of my choices for root operations include destruction, resection, transplantation, and excision, which all seem similar, don’t they?

Luckily, the introduction to the ICD-10-PCS manual provides a specific definition for extirpation, which is “taking or cutting out solid matter from a body part” (e.g., removal of a calculus). I’m glad this definition was in the manual otherwise I would have had a hard time using the official definition.

One of the comments people made at the AHIMA session was, “Will all my physicians have to document ‘extirpation’?”  Rest assured, physicians do not need to use this exact verbiage for coders to assign the appropriate ICD-10-PCS codes.

However, because of the way the ICD-10-PCS system is set up, you do need to understand what the root operations are so you can reference the correct part of the procedure tables, identify the procedures the physicians document, and assign the correct codes.

My experience at an AHIMA trainer session

I recently completed the American Health Information Management Association (AHIMA) Academy for ICD-10 trainer session in Grapevine, TX. It was a whirlwind experience. The days were long, but it was fun to learn something new.

I am convinced now more than ever that ICD-10-CM is very much like ICD-9-CM. But ICD-10-PCS will take some getting used to.

For ICD-10-CM, we still follow the same steps to assign codes—they just don’t look like our beloved ICD-9-CM codes. I have memorized so many codes over the years (as I can imagine many of my fellow coders also have), so this will be one of the hardest adjustments to make. With ICD-10-CM, we will have to exercise our minds into learning and memorizing new codes. For example, all of us in the training session learned a new code the first day that I will never forget—I10 for hypertension!

There are definitely aspects about ICD-10-CM that I am excited about. We no longer need to concern ourselves with determining whether hypertension was benign or malignant or whether diabetes is uncontrolled or not stated as uncontrolled because ICD-10-CM codes are not differentiated in this manner.

For conditions such as septic shock, it is wonderful that we will have a combination code for sepsis with septic shock (R65.21). In ICD-9-CM, we generally have to report three codes (systemic infection, 995.92, and 785.52). With ICD-10-CM, we have to report only two codes: The underlying condition first and R65.21. Overall, we are still making progress in simplifying the system.

ICD-10-PCS is a whole different ball of wax! Stay tuned to hear more about this in a future blog. Have you attended one of AHIMA’s trainer sessions? What was your experience like? Share your comments here!

Part 3: One coder shares list of cost-effective ICD-10 resources

Looking back a year later, I now feel relatively confident in my background knowledge of ICD-10. And I did not spend any money. Read more in Part 1 and Part 2 of this blog post about my cost-effective strategy to learn about ICD-10.

As soon as I know whether there will be a freeze date, I will make plans to create/update my own personal coding references and training materials accordingly.

One possible expenditure I would recommend would be the purchase of the American Health Information Management Association’s (AHIMA) practice exercise text on ICD-10, which is based on the 2009 code set and guidelines, and you can also take the proficiency assessments for validation of your self-education efforts.

I’m not too concerned about the possibility of the ICD-10 code set changing again a couple more times because I would just update the current desktop files that I use and just know that a few of the codes in the answers in the AHIMA text I reference above may be outdated. These potential changes will not significantly hamper your studies to the point that it would be worth purchasing an updated text. My personal plan is to not make any significant expenditures until I know about whether CMS will impose a code freeze.

So bottom line, you already know ICD-9 and the general coding conventions and guidelines, so it’s just a matter of understanding the differences in those guidelines and conventions in ICD-10 (Find out by reading the ICD-10-CM official guidelines and the ICD-10-PCS official guidelines found in Appendix B of the Reference manual.) and then download the files (one for the PCS and the index and tabular for ICD-10-CM) and start coding in ICd-10 what you code daily for practice.

If you need extra support and don’t have access to real patient records, then use AHIMA’s textbooks and/or create your own training materials. The textbooks on ICD-10 are the same books that the AHIMA will use in the Train the Trainer sessions. Yes, the AHIMA’s sessions will also have training slide presentations, but you can train your staff by just sitting down and coding your hospital records in ICD-10.

Because the AHIMA has copyrighted their training materials and slide presentations, you can’t take them back to your facility or school and incorporate them into your programs. When the question was raised in the Assembly on Education community of practice (member’s only discussion board) regarding whether the AHIMA’s training materials that attendees receive at the Train the Trainer programs could be used freely for any other setting or for any other entity even within your own organization, the AHIMA clarified that the training materials (e.g., Coding Training Manual with Exercises) are copyrighted and cannot be used internally or for any other purpose. Any entity that you teach using these materials must purchase multiple sets of these training materials at a bulk rate discount.

Familiarize yourself with ICD-10 by reviewing the following free information that I compiled. You will find overlap for some of the information, but one thing you will not want to miss is the AHIMAs’ field test project done in 2003 for ICD-10. Consider my list of must-have resources:

• AHIMA’s ICD-10 page: Includes a list of all the CodeWrite issues with the ICD-10 checkpoints in them as well as other articles on ICD-10)
• AHA ICD-10 resources
• AAPC’s Web site on ICD-10
• CMS’ conference calls on ICD-10: I listened to calls from 2008 and 2009, reviewed the presentations and transcripts, and even wrote up a summary on one of the latest 2009 calls
• Excellent article on ICD-10-CM: I used this article to get my first introduction to ICD-10-CM
• Excellent article on ICD-10-PCS: I used this article for a school paper on ICD-10-PCS
• ICD-10 Coding Corner: This has multiple coding scenarios that you can practice with for free, with answers from ICD-10-CM and ICD-10-PCS.
• International Federation of Health Records Organizations’ (IFHRO) international training on ICD-10 sponsored by AHIMA Foundation Of Research and Education
• Also, be on the lookout for local AHIMA chapter training programs or local AMA/AHA training programs or local Medicare contractor training programs.

Part 2: One coder’s cost-effective strategy for education

In my last blog post, I explained how I tackled the challenge of educating myself about ICD-10, realizing the significant cost that would be associated with registering for every ICD-10 Webinar, seminar, and educational session under the sun.

In addition to creating quizzes and memory aids to help myself learn ICD-10 codes, I also worked to refine my own coding reference Excel spreadsheet, which became a valuable tool and part of my daily routine.

I read through most of the 2003 Draft ICD-10-CM Official Guidelines for Coding and Reporting for Acute Short-term and Long-term Hospital Inpatient and Physician Office and other Outpatient Encounters and then I began to crosswalk a homegrown coding reference Excel spreadsheet that I currently use on a daily basis to ICD-10. My plan was to complete crosswalking my spreadsheet and then after purchasing an ICD-10 Manual, proceed to practice assigning ICD-10 codes for charts that I code on a regular basis.

I also started to incorporate ICD-10 into my daily discussions with other coders. When I answered an ICD-9 coding question, I would also provide the ICD-10 codes, especially when the discussion was about controversial, problematic issues related to ICD-9 (e.g., there is not a specific enough code). I felt that this daily application and routine of looking up of ICD-10 codes for various questions that I answer on listservs and through other informal coding discussions would get me into an ICD-10 coding frame of mind.

After that, I started to read through the ICD-10-PCS reference manual, and I started memorizing the characters for each section and body system for the procedural coding system. I also planned to create a quiz on the structural differences between ICD-9-CM Volume 3 and ICD-10-PCS. I had recently written a comprehensive training module on ICD-9-CM Volume 3 procedures, and my plan was to update that training module as well as any other ICD-9 Volume 3 reference sheets that I had.

At the beginning of 2009, I noted the updated 2009 official coding guidelines, namely  ICD-10-CM Official Guidelines for Coding and Reporting, and prepared notes detailing the differences between the 2003 and the 2009 guidelines. I also updated my coding files that I had downloaded to my desktop for daily use to reflect the new 2009 coding system.

At that point, I had heard about the possible freeze of ICD-10, so I decided to hold off on completing the conversion of my diagnosis and procedure reference sheets and training materials until at least 2010 in hopes of being able to plan around any possible freezes. Access a recent ICD-10 Watch post to learn more about this possible freeze.

I continue to code with ICD-10-CM and ICD-10-PCS when answering coding questions, and I continue to study the ICD-10-PCS reference manual. If you’re looking for a low-cost strategy for acquiring ICD-10 education, keep in mind that all of this practice using ICD-10 costs only my time.

Tune in for my next blog post, when I share some ideas for building on this foundation of knowledge.

Has your coding team come up with some cost-effective strategies for learning about ICD-10? Post a comment, and share your tips with other ICD-10 Watch subscribers.

AAPC shares perspective on coder training

Since the Department of Health and Human Services’ January announcement on the final rule for the implementation of ICD-10, many questions have popped up. Some in the industry feel that if they do not contract a trainer or a consultant to provide training right now, they will fall behind and not meet the October 2013 compliance date.

However, the American Academy of Professional Coders’ (AAPC) emphasizes that now is not the time to begin training. Will you really remember everything you’re learning in 2009 four years later in 2013? Chances are that you will not, and to make the implementation as seamless and efficient as possible, the AAPC recommends holding off on training for the time being.

Our plan is unique in that our trainers will undergo an intensive “Train the Trainer” program, which we are not opening to the general healthcare population to ensure consistency with correct information conveyed to the healthcare community.

I must reiterate that now is not the time to begin learning the ICD-10 code set. The best time to begin is late in 2012 or early 2013. The AAPC has streamlined its training curriculum into different phases, starting this summer, when the association will give a three-part, free introduction to ICD-10 implementation Webinar. For more information, visit the AAPC’s ICD-10 Web page.

Some AHIMA training sessions already sold out

The American Health Information Management Association (AHIMA) is hosting three sessions of the “Academy for ICD-10-CM/PCS Trainers”:

• July 24 – 26, 2009 | Las Vegas, NV | Planet Hollywood Resort SOLD OUT
• September 9-11 | Chicago, IL | AHIMA National Office SOLD OUT (1st session); but AHIMA added a 2nd session
• October 8-10 | Grapevine, TX | In conjunction with the AHIMA Convention and Exhibit

I was already planning to attend the national AHIMA convention October 3-8th and thought it would be a great time to attend the “train the trainer” sessions following the convention. Why make two separate trips right? Well, I had no idea that getting a seat in one of these sessions would be such an ordeal. I was concerned about registering for the October session after seeing how the first two locations were already sold out and they were more than two months away!

So, I called the AHIMA to inquire about the number of seats they had in these sessions because they seemed to go like hotcakes. The very nice representative e-mailed me and explained that they were only allowing 50 people per session (at the time) and that registration would not be available until May 1.

I marked my calendar to make sure I registered on May 1, when the registration opened. I felt like I was a teenager waiting for the hottest concert tickets to go on sale at 8 a.m. (minus the sleeping outside in the cold – not that I have ever done that anyway!)

I logged on at 8:30 a.m. EST, and registration still wasn’t available. Of course, I now remembered that the AHIMA is in Chicago, which means they are on CT. I logged back in at 9:30 a.m. EST and was able to register. Whew! I got a seat! I was so excited.

I did notice that they have now increased the maximum number to 100 attendees.

I sure hope this training is as valuable as I expect. The price is $1,900! The AHIMA doesn’t mess around being that this education will bring in approximately $190,000 per session. I am glad it is a nonprofit organization.

I am not sure whether the reason it is such a hot commodity right now is based on the fact that attendees are being proactive to get their organization ready or whether it is because there is going to be a band wagon of people “putting out shingles” that they are AHIMA certified ICD-10-CM/PCS trainers. I know that I intend on using the knowledge to share with the thousands of students who have come to rely on HCPro for their training.

If you’re not ready to dive in, start by getting your feet wet

We’ve read the words of caution and heard the urgency of the message: Don’t put off planning for ICD-10. And while there is no one-size-fits-all plan for implementation, there is one tip that everyone should bear in mind: It’s too early for coder training in ICD-10. Think about how well people retain information over time. Can you remember all of the coding guidance in Coding Clinic from six months ago? Can you remember the top 10 tips you learned at your last in-service training? Now imagine trying to remember all the knowledge you might gain in a week’s training four years from this point.

So what should coders be doing right now? Look at the basic coding conventions and the most obvious differences involved with the new coding system. For example, start with small nuggets of information and build on that slowly. Do you know what an Excludes 1 or an Excludes 2 note indicates?

Excludes1: Denotes “not coded here,” meaning coders should never report the excluded code at the same time as the code above the excludes1 note (e.g., the congenital form versus an acquired form of the same condition).

Excludes2: Denotes “not included here,” meaning that the condition excluded is not part of the condition represented by the code even though a patient may have both conditions at the same time. When an excludes2 note appears under a code, coders can report both codes together, when appropriate.

That wasn’t so bad was it? So for the coding side of this transition, start now but start small.