Dual Coding versus Double Coding: An ICD-10 Implementation Plan

Dual coding or is it double coding? That is a very good question to ask yourself as you work toward ICD-10 implementation. The difference can be confusing when you first read the phrase, but know this….dual coding can be your avenue to successful ICD-10 transition in your organization. 

Dual coding means coding in both ICD-9-CM and ICD-10-CM/PCS for the same record, using each code set and all of the associated coding conventions and guidelines (some also call this “native coding”).  It does not mean using mapping or crosswalks to assign codes in another code set following the initial code assignment. 

Dual coding does not mean coding every record in both code sets; that would be “double coding” and that would be extremely labor intensive.  However, is 100% dual coding reasonable as a desirable strategy?  At this juncture, with approximately 18 months to implementation date, health care facilities cannot afford 100% review; even for a short period of time.  What works is a well-designed dual coding program.  One that only codes selected cases can have as much, or more, benefit than 100% re-coding of records.

Elements of a well-designed program are:

  • Strong teaching method – There is no better way to learn what you don’t know than to perform “a trial” in a safe environment.  Learning in “dual coding mode” can supplement other training methods and may even reduce your overall training costs.
  • Coding confidence builder – Coders gain speed and accuracy in the new system in a controlled environment.  Confidence is built with every successful code assignment and every aspect of new learning.
  • Documentation assessment – By tracking missing documentation, the dual coding method provides immediate feedback to the clinical documentation improvement process.  Paying for a documentation assessment by outside vendors is not necessary.  By keeping this element internal, your coders can strengthen their skills and locate missing documentation within records of which they are most familiar.
  • Database testing – Dual coding provides the robust database necessary to participate in end-to-end collaborative testing with payers.
  • Financial analysis – While CMS says that the ICD-10-CM/PCS implementation will be budget neutral; CMS meant their budget and not yours.  There will be winning and losing service lines within your case mix rendering a potential loss or gain in revenue.  Dual coding can give the financial analysts the data they need to move forward with ICD-10.

While you may have heard this before, there are a few things that you need to consider before starting a dual coding strategy. 

  1. ICD-10-CM/PCS training- This should be complete before the strategy can be implemented.  While the coders will not know everything when they begin the dual coding process, they should have practiced both ICD-10-CM and ICD-10-PCS systems and the new terminology. 
  2.  The level of IT readiness- Vendors need to be able to create separate databases for ICD-9 and ICD-10 and to allow “native” coding in both systems.  .  Crosswalks will not work.  With training and IT infrastructure in place, the only thing left is a manageable dual coding strategy.

The best strategy is one that is tailored to meet your needs.  Here’s a sample strategy to get your planning moving in the right direction:

  • Divide and conquer – Assign DRGs to the coders with the best technical skills on the subject in ICD-9-CM, helping develop them into “super coders” for certain diagnostic conditions and/or surgical types in ICD-10-CM/PCS.  Not all coders need to code the same DRGs.
  • Quantity matters – Watch the budget and don’t attempt more than you can afford.  Try for a goal of no more than 3% to 5% of your discharges over time.  Do the math to determine how many records should be coded in both systems during an average work day.  Schedule carefully to minimize backlogs and loss of productivity.
  • Just the right stuff – Consider limiting the cases to your top 20 DRGs by volume and any other top-revenue-producing DRGs.  This is an efficient strategy to learn the most about your organization. 
  • Sequential coding is best – Have coders read the record and code in ICD-9-CM as they normally would.  For the cases chosen for dual coding, have the coders assign the ICD-10-CM/PCS codes immediately following that.  This way, the clinical story is fresh in their mind. They can also see the differences in the code set more clearly and recognize the new documentation required for ICD-10.
  • Create a “Most Wanted List” – Track the missing documentation and share with the provider staff to help capture what you need before the implementation date.
  • Brainpower required – New learning takes a fresh brain.  Consider having coders do their dual coding cases early in the day to maximize learning and avoid frustration at the end of their day.
  • Time is of the essence – Start as soon as your training schedule and IT infrastructure will allow.  With approximately 18 months to go, now is the perfect time. 
  • The power of sharing – Provide time for coders to discuss their difficult cases and share what they’ve learned about the new systems. Provide supplemental training on areas that present the biggest coding challenges.

Be strategic as you work towards the implementation date.  Use dual coding to your advantage and your overall implementation strategy and you will find yourself successful at implementation date and onward.

Published Date: 

Tuesday, February 26, 2013