Inpatient Coder
The final rule implementing ICD-10-CM and ICD-10-PCS identifies the need for 50 hours of training for inpatient coders to learn the ICD-10-CM and ICD-10-PCS systems. This recommended 50 hours of training presumes that coding professionals already possess the required knowledge in the biomedical sciences (anatomy, physiology, pathophysiology, pharmacology, and medical terminology) that will be needed to correctly apply codes using the ICD-10-CM and ICD-10-PCS systems.
For successful transition to ICD10, the challenge for inpatient coders is to:
- Ensure they have sufficient foundational knowledge of the biomedical sciences
- Learn how to apply both ICD-10-CM and ICD-10- PCS codes correctly on inpatient encounters
- Understand how to apply maps and crosswalks between ICD-9-CM and the ICD10 systems
Earlier steps for inpatient coders in this model focus on obtaining the foundational knowledge of the biomedical sciences and understanding how ICD-10-CM/PCS are different from ICD-9-CM (including familiarity with the maps between them). One to two years prior to implementation, the focus is more in depth understanding of the fundamentals of ICD-10-CM/PCS and preparing to code with these new systems. In the year prior to implementation, the focus is on becoming an expert in applying ICD-10-CM and ICD-10-PCS codes to inpatient encounters.
To Do Phase 1:
- Understand the ICD-10 final rule and its implications to your coding position.
- Learn about the structure, organization, and unique features of ICD-10-CM and ICD-10-PCS.
- Use assessment tools to identify areas of strength/weakness in the biomedical sciences (e.g. anatomy and pathophysiology).
- Review and refresh knowledge of biomedical sciences as needed based on the assessment results.
- Begin studying ICD-10-PCS definitions (root operations and approaches).
- Begin learning about the general equivalence mappings (GEMs) between ICD-9-CM, ICD-10-CM, and ICD-10-PCS.
Corresponding Resources:
- Review The Final rule on ICD-10-CM/PCS (1)
- Read AHIMA’s analysis of the rule (1)
- Read "Coding Injuries in ICD-10-CM" published in the January 2011 Journal of AHIMA (2)
- Listen to free archived audio seminar, From Point A to ICD: Successfully Implementing ICD-10-CM/PCS, March 2011 (2)
- Buy AHIMA publication: Pocket Guide to ICD-10-CM and ICD-10-PCS (1,2)
- Buy Root Operations: Key to Procedure Coding in ICD-10-PCS (1, 2)
- Purchase archived audio seminars: "ICD-10-CM Coding Guidelines: An Overview", August 2010; ICD-10-PCS: Bridging the Gap in Anatomy and Physiology, October 2010; ICD-10-PCS: Getting to the Root of the Procedure,Part 1 and ICD-10-PCS: Getting to the Root of the Procedure, Part 2; May 2010; ICD-10 Prep: Assessing Coders' A&P Proficiency, June 2011(2)
- Buy ICD-10-CM and ICD-10-PCS Preview, second edition (2)
- Read the article “Brushing up on ICD-10-PCS” in October 2007 Journal of AHIMA (2)
- Take an Anatomy and Physiology (A&P) refresher course such as AHIMA’s Clinical Concepts for Coders or for more in-depth training, AHIMA’s Coding Basics A&P: Core Lessons for Health Professions course or an A&P course at a local college or university) (4)
- Read “Differentiating Procedure Approach in ICD-10-PCS: Fifth Character Captures Specificity” from the October 2009 Journal of AHIMA (5)
- Read the article “Where the Rubber Meets the Road: Application of ICD-10-PCS Coding in Complex Surgical Scenarios” in October 2008 Journal of AHIMA (5)
- Read “Putting the ICD-10-CM/PCS GEMs into Practice” from the March 2010 Journal of AHIMA (6)
- Take AHIMA’s online course, ICD-10-CM/PCS: Fundamentals of General Equivalence Mappings (GEMs) (6)
- Purchase Transitioning to ICD-10-CM/PCS: The Essential Guide to General Equivalence Mappings (GEMs) (6)
To Do Phase 2:
- Review code structure and coding conventions for ICD-10-CM and ICD-10-PCS.
- Learn the fundamentals of the ICD-10-CM and ICD-10-PCS systems.
- Analyze and practice applying the ICD-10-CM and ICD-10-PCS Coding Guidelines.
- Continue to study ICD-10-PCS definitions (memorize the definitions of approaches and root operations).
- Continue to review and refresh knowledge of anatomy and physiology concepts
Corresponding Resources:
- Review the ICD-10-CM and ICD-10-PCS Official Coding Guidelines (corresponds to item #1 & #3)
- Listen to free archived audio seminar, From Point A to ICD: Successfully Implementing ICD-10-CM/PCS, March 2011 (2)
- Purchase archived audio seminars: "ICD-10-CM Coding Guidelines: An Overview", August 2010; ICD-10-PCS: Bridging the Gap in Anatomy and Physiology, October 2010; ICD-10-PCS: Getting to the Root of the Procedure,Part 1 and ICD-10-PCS: Getting to the Root of the Procedure, Part 2; May 2010; ICD-10 Prep: Assessing Coders' A&P Proficiency, June 2011(2)
- Take AHIMA's online courses, ICD-10-CM Overview: Deciphering the Code (2, 3, 5)
- Take AHIMA's online Clinical Documentation Improvement in Preparation for ICD-10-CM/PCS and AHIMA ICD-10 CM Coder Readiness Assessment(3)
- Buy AHIMA publications: ICD-10-CM and ICD-10-PCS Preview, second edition, ICD-10-CM and ICD-10-PCS Preview Exercises, and Root Operations: Key to Procedure Coding in ICD-10-PCS (3,4)
To Do Phase 3:
- Become an expert in applying ICD-10-CM and ICD-10-PCS codes to inpatient cases in the 6 to 9 months preceding the implementation date
- Practice using ICD-10-CM and ICD-10-PCS codes each week leading into “go live” on the implementation date
- Network with peers to seek answers to cases and confirm application of ICD-10-CM/PCS codes
- Take advantage of component state association (CSA) training opportunities