Dual Coding - Friend or Foe?
Friday, January 30, 2015 09:19 PM

Jill Foote, Insurance Quality Analyst III

Many providers are under the impression that two or three months is sufficient time to prepare for the transition to ICD-10.  Thankfully, we have many other countries' experiences to draw from and know that a few months is not near the average time for implementation.  In this article, we cover the concept of dual coding, which refers to coding the same record in both ICD-9 and 10 for training and testing purposes.

Dual coding can be especially helpful when vendors begin testing their systems for ICD-10 transactions. This will require you to work closely with vendors and payers early in the implementation process. What can you do to get ready? Listed below are a few simple steps:

 Create a list ICD-9 codes commonly used in your clinic as outlined in Step #2 of ACA's Implementation Checklist.
 Look up the ICD-10 GEMS for each of your ICD-9 codes and make a list. Looking up the GEM (General Equivalence Mapping) is the first step to finding and choosing from the full list of equivalent codes.  ACA's ICD-10 Toolkit contains a helpful ICD-9 Conversion Worksheet along with a list of fully mapped ICD-10 codes, called the Mapping Tool, to assist your clinic with this step.
 Schedule ICD-10 Training for you and your staff.  ACA's online webinars and State Trainings provide education tailored to the needs of the chiropractic profession.
 Choose 1 to 2 cases per day and code the case in ICD-9 first.  Then look up and assign the ICD-10 code that most closely matches each patient's condition(s).
 Compare the differences in the code sets and analyze areas that need improvement in your documentation to support the specificity within the ICD-10 code definition.
 Create a "MID" (Missing in Documentation) list. The Team Leader can use this list to track missing documentation and then work with the clinician areas where improvement is needed to support the specificity of ICD-10.
 Record the amount of time it takes to carry out the dual coding process and make note of this for when you begin budgeting your implementation costs related to productivity. ACA's ICD-10 Toolkit contains a helpful printable Budget Worksheet to assist you with this important step.
 Follow up with vendors to obtain information regarding their "acknowledgement testing" and "end-to-end" testing schedule. ACA's ICD-10 Toolkit also contains a helpful printable Vendor Worksheet.


There are significant advantages to developing a dual coding process in your clinic--namely, safeguarding revenue.   Countries that have already implemented ICD-10 reported a 50 percent drop in medical coding productivity and one year later, productivity remained at 40 percent lower than normal.  By initiating this method of coding early in the implementation process, your billing staff will gain speed, accuracy and confidence, which can lead to increased productivity and revenue.

The article Why You Can't Afford to Delay Dual Coding  states "The key in being able to code and bill properly is whether the data is documented in the charts. If it's not there, then this whole thing goes off the rails really quickly. Going through the dual coding process shows where physicians have gotten on board with documentation specificity and where to focus more attention because your revenue is at risk." The dual coding process allows providers to schedule time to discuss challenging cases with staff and make needed adjustments in documentation.

Most importantly, your clinic will have the necessary test data in order to properly evaluate vendor readiness through end-to-end testing. This information will be valuable for your financial impact analyses to compare average reimbursement under ICD-9 to reimbursement under ICD-10.

Clinics should begin now to make time for dual coding or later face potential longer reimbursement cycles, denied claims, frustrated staff, and lost revenue. If you begin to prepare now, you will more likely be able to identify and address coding errors, workflow and budgetary concerns, and documentation inaccuracies before they begin to impact your reimbursement. ACA encourages all clinics to take advantage of the helpful ICD-10 resources listed in this article which can also be found at www.ACAtoday.org/ICD10.

Source:  ACA: In Touch - December 2014