Journal of AHIMA - January 2011

The transition to ICD-10-CM/PCS will ramp up in 2011, with part of the implementation focus shifting to initial training for coders.

But before coders learn the new code sets, many will require refresher training on anatomy and physiology, says Anita Majerowicz, Many coders have not studied the anatomy and physiology of the body since their first months in college, which for some was decades ago. However, the increased detail and specificity of ICD- 10 requires sharper A&P skills in order to properly use the new code set, says June Bronnert, RHIA, CCS, CCS-P, the director of clinical data standards at AHIMA.

ICD- 10
Coders start A&P training
This year marks the point when
coders should start seeking
refresher courses on anatomy
and physiology.

“Especially when you get into ICD-10-PCS, looking at how the
procedures are performed, you have to know where in the body
you are and what is being done,” Bronnert says. “And it has that
granular detail that current ICD- 9 coding professionals didn’t
have to know.”
The final rule that established the ICD- 10 switch estimated
that coders will require 50 hours of training to use ICD-10-CM/
PCS. But that estimate does not account for background train-
ing such as A&P.

Coding managers should take caution in assuming how much A&P, medical terminology, and biomedical sciences knowledge their coders have, Majerowicz says. Assessing individual training needs will be an important first step in designing appropriate training. If coding staff are at various knowledge levels, a training program that dives into advanced cases risks leaving some staff behind, she says.

Many healthcare facilities will begin evaluating coders’ knowledge through assessment tests this year and then use the results to design their A&P training programs. Several state AHIMA associations are working with local community colleges to offer classes tailored to current coding professionals.

Attention to scheduling will help minimize disruption. Training will take place while coders are working to fulfill their usual duties, so spacing out educational sessions over time will minimize the impact to coder productivity, Majerowicz says.

Electronic health information exchange will be a major story to watch in 2011 as the federal government expands access to the Nationwide Health Information Network and tests a simplified version intended to aid the meaningful use program.

This summer the Office of the National Coordinator is expected to release NHIN governance rulemaking, which will allow healthcare organizations and HIEs the ability to use the Inter-net-based information exchange network without a formal government contract. The rulemaking will dictate the way participants must use the NHIN. This includes developing privacy and security governance, interoperability technical requirements, and general NHIN oversight mechanisms, Viola says.

A simplified version of NHIN, called the Direct Project ( formerly NHIN Direct), begins pilot-testing this month. The version allows providers to securely share clinical information in one-to-one exchanges with other providers.

While NHIN is considered for use in larger and more complex exchanges, the Direct Project allows providers to do the simpler health data exchanges required under the first stage of meaningful use.

Add in the infusion of federal funding to state-level health information exchanges, and 2011 will be a big year for information exchange.

As more providers move away from fax and mail and begin using NHIN, Direct, and other HIE systems in 2011, HIM professionals must still ensure incoming and outgoing records meet privacy, security, patient consent, and data quality standards, says Harry Rhodes, MBA, RHIA, CHPS, CPHIMS, FAHIMA, director of practice leadership at AHIMA.

“The ability to exchange information is going to create new
uses and new requests for use that you are not familiar with,
and you will have to test the legitimacy of the use,” Rhodes says.
“[HIE] is going to test current thinking.”
The Direct Project is expected to simplify HIE, even create the
ability to set up a direct feed of exchanged data between health-
care entities. But the exchanges won’t be successful and secure
without traditional data integrity vigilance, Rhodes says. HIM
will also need to consider how to integrate exchanged records
into the system in a way that actually improves healthcare de-
livery.

The use of HIEs, NHIN, and Direct in 2011 will mean the start of new and adapted forms of information exchange quality assurance for HIM professionals.

“You are still going to be concerned with the quality and integrity of that data,” Rhodes says. “Even though it is coming to you in this Direct [Project] link, it is not like you turn on Direct and forget about it. You are still going to have to run some algorithms to make sure the data are not getting corrupted and that the record is actually being delivered.”