Look Towards Canada for Implementation Experience

When looking into preparation for the upcoming 2014 change from ICD-9 to ICD-10, it might be of help to seek out experts with experience in this update process. You will not find institutions with actual experience in the US, because while some hospitals are in test phase, none have actually implemented the change. It is after all not scheduled until October 1st of next year.

You are in luck because the Canadians have already been through this process. The American Health Information Management Association (AHIMA) directs you to a look at a Canadian transition. Humber River Regional Hospital (HRRH) went through the ICD-10 transition process, during which the hospital staff gained an in-depth knowledge of the effects of implementation especially as they relate to information systems and coding staff.

The Story of a Canadian Hospital’s Transition

HRRH is a three site general hospital in Toronto. During implementation there were 605 beds and annual patient coding covered 30,000 inpatient visits, 102,000 emergency room visits, and 35,000 outpatient surgery visits.

The Clinical Data Collection/Coding section reported to the Director of Financial Planning and Decision Support. During transition there were 16 data coding staff, three Clinical Information Utilization Analysts and management staff needing to be trained on ICD-10. ICD-10 Canadian classifications were used starting in April 2001.

Efforts for staff training began when HRRH focused on the education of key individuals selected to implement the new classification system including the test and evaluation process. These specially selected staff members assumed leadership roles in helping guide the remaining staff transition from ICD-9-CM to ICD-10.

Challenges of finding the expert training needed were met by Douglas College in New Westminster. They worked closely with the Canadian Institute for Health Information. British Columbia trained their students for an entire year creating much available course material.

AHIMA Recommendations for US Training

In the US everyone will be starting ICD-10 coding on the same date.

AHIMA makes the following recommendations on training:

  1. Training should not begin earlier than April 2014.
  2. Individual training is likely to take 50 hours for inpatient coders but training varies by organization.
  3. A physician’s practice need only learn ICD-10 diagnosis coding.
  4. Coders of hospital charts need to learn ICD-10 inpatient procedure coding as well as ICD-10 diagnosis coding.
  5. As in the Canadian example, AHIMA suggests finding specialty-specific ICD-10 training offered by professional organizations. It’s important to note that ICD-10 coding training is an essential requirement for certified coders. You can visit www.cms.gov/ICD10 anytime during the transition process to obtain the latest training information.
  6. Here is AHIMA’s database of approved trainers.

Canadian Hospital Coding Rates on Conversion

In the period from April 2002 to April 2003 inpatient coding changed negatively from 4.62 to 3.75 charts completed per hour. Day surgery coding changed from 10.68 to 8.53 charts completed per hour. Emergency surgery charts completed per hour declined from 10.37 to 8.

Looking at a year’s results of ICD-10 coding it is apparent that the rate of charts completed per hour declined by approximately 20% during the one year period. Considering the major changes from ICD-9 to ICD-10 this is likely to be a good result.

Perhaps the most important factor in a successful conversion is professional training that can ensure that staff is up to speed on all aspects of ICD-10 in a timely manner. It is hoped that the Canadian example can provide some good insights into implementation requirements and outcomes.