Long Term Care

While there may be some similarities and overlap between settings this model will focus on roles in the LTC community and focus on steps to take to prepare. In order to prepare for implementation identifying who will need education, and knowledge level is a key step in successful implementation. There are many LTC roles impacted by the transition.

Below is a list of various roles that will require ICD-10-CM education before implementation:

• HIM personnel
• Independent HIM Consultants
• Nurse Managers
• Health Information Trainers
• MDS Nurses
• Nursing unit staff/clerks
• Case managers
• Corporate Office personnel
• Compliance Office personnel working with ICD coding
• Corporate administrative departments
• Administration
• Therapist (PT, OT, ST)
• Billing/Admitting personnel
• Medical Directors/Providers

One method in evaluating educational needs is to separate the roles into two groups: a group that primarily assigns codes and one that primarily does NOT assign codes. Each group requires different levels of ICD-10-CM knowledge. The different knowledge levels are typically defined as:

• Awareness which could be considered a general knowledge of the code system and important differences between ICD-9-CM and ICD-10-CM
• Use/professional knowledge level which would be for an individual who uses coded data but is typically not assigning codes daily
• Application of the code set would be for those individuals who are routinely applying codes

Roles that DO NOT assign codes are impacted by ICD coded data but are not responsible for the selection of the initial code. These roles still require education as the classification system is part of their current role. Roles that ASSIGN codes are grouped into the following broad categories:

• Current credentialed HIM person who knows ICD-9-CM
• Employees with experience in coding who were trained on the job (not professionally)
• Coding individuals or staff members who are new to coding who have education in anatomy/physiology, medical terminology, and pathophysiology

Code assignment is performed by various roles in LTC, but typically the health information management (HIM) roles assign the ICD codes. However the backgrounds of these individuals range from no formal education regarding ICD coding to possessing a HIM credential.

A coding professional’s educational time is estimated at 10 hours to learn ICD-10-CM by the Federal Register final rule for implementing ICD-10-CM. The education time should be considered cumulative and not continuous. Experienced HIM professionals currently trained in ICD-10-CM estimate educational time will be greater than estimated times published in the Federal Register. Sixteen hours for the credentialed HIM professional, eighteen hours for an employee experienced in coding, and thirty six hours for a brand new individual without formal education is being suggested. An exact total time of education varies based upon the needs of each individual’s skill level. Individuals currently coding need to obtain education on ICD-9-CM system regarding structure, organization and official coding guidelines to insure correct understanding of current coding practices and to allow for a smooth transition to ICD-10-CM.

It is recommended that intense coding education not be initiated until six to nine months before implementation  however there are steps to take now to be prepared for the transition.

Below are a few general suggested topics. This is not an all inclusive list. Organizational and individual assessments need to be included in topic determinations.

• Structure of ICD-10-CM as it provides greater specificity of conditions and diagnoses.
• Format, conventions and guidelines of ICD-10-CM
• Injury coding, such as fractures, dislocations, sprains and use of extensions in ICD-10-CM