ICD-10: Dual Coding vs. Double Coding

By: Andy Sager

As Product Marketing Manager for the 3M Coding and Reimbursement System, my job is to make sure the software truly meets the needs and expectations of coders. While researching and preparing our coding products for ICD-10, I’ve heard a lot of buzz around dual coding, but after looking into it, I’ve been surprised by the many definitions of dual coding that are out there.

One conversation I had with an HIM professional went this way:

HIM Director: “We are going to begin dual coding first quarter of 2012.

Andy: “What do you mean by dual coding?

HIM Director: “We are planning to hire additional staff that will recode, in ICD-10, a portion of our already coded claims.

Andy: “So you will take your claims that are already coded in ICD-9 and have a different coder recode the claim from scratch in ICD-10 so you can identify the impact ICD-10 will have on your organization…

After thinking about our conversation, I realized this HIM director was describing a process that was really double coding.  This director wanted the ICD-9 coding to be independent from the ICD-10 coding.

I’ve had conversations with other customers about their desire to derive both ICD-9 and ICD-10 codes on the claim at the same time.  This falls into a dual coding definition.

So for simplicity, when describing the two different approaches, here are definitions that should help you moving forward:

Dual Coding = Dual Coding is adding both ICD-10 and ICD-9 codes simultaneously to the record

Double Coding = Double Coding is coding the record twice for two different classifications, or natively coding the record for ICD-10 after it has already been coded for ICD-9

By recommending consistent definitions for these two coding scenarios, I’m not suggesting your organization should take one approach over the other.  What these definitions should do is help standardize the discussion, so we can all clearly communicate as we transition to ICD-10 together.

__________________________________________________

Still have questions? Check out Andy Sager’s update on Dual Coding vs. Double Coding: Part 2.

11 responses to “ICD-10: Dual Coding vs. Double Coding

  1. I’m a little confused. As of October 1, 2013 the only diagnosis codes to be entered on your claim is an ICD-10. You cannot have both ICD9 and ICD10 on the same claim. The ICD9 DX will be denied.

    ICD9 codes will be independent from ICD 10, but your billing systems will have to accommodate both, because after 10-1-13, you will have ICD 9 claims that will deny or need corrections and will have to bill as they did prior to 10-1-13.

    I’m also confused as to why anyone would double code.

    • Vicki,
      There is some talk about whether; all insurance companies, Medicaid – in some states, Workman’s Compensation – in some states are going to be ready to use ICD-10. I don’t have all the facts, but have heard rumor that CMS exempted Workman’s Comp from ICD-10 meaning it is their choice whether they use 10 or not.
      In our state Medicaid uses current codes but Version 12 DRG’s, so go figure……

    • Linda J. Pigue

      That’s a validate point Vicki. There is no need to indicate ICD-9 and I-10 on the same claim. In fact, it doesn’t make sense. Dual coding will exist in medical documentation. For example, if doctor service patient prior to 10/2013, and the same patient is seen on 10/02/2013, the doctor has to translate the I-9 code to I-10 code; however, the bill should be dropped using the I-10 code only for the 10/02/2013 visit.

  2. Charlie Bernstein

    Before October 2013, Dual coding could be used to have coders start coding in ICD-10 and derive both the ICD-9 code for billing. The ICD-10 code can be saved and initial reporting can be done. After October 2013, there are two potential uses for dual coding. First, there are some systems that may not be moving to ICD-10 initially. Workman’s compensation claims may need to be submitted via ICD-9. Second, there are some reports that require 3 or more years of data. If your reports include 2 to 3 years of ICD-9 data, deriving the ICD-9 code along with the ICD-10 code could be used for continuity with these reports. Double Coding could be used to generate both the ICD-9 and ICD-10 codes before full dual coding is implemented in a coding system. (Blog administrator note: Charlie Bernstein is a product marketing manager with 3M Health Information Systems)

  3. I just took a ICD 10 course and found it alot easier than it has been made out to be. If you are an accredited coder, there should be no hold up or problems once you have the basics of ICD 10. You indicated that there might be some systems that may not be moving to ICD 10, I didn’t think there was any wiggle room when it came to being ready to bill ICD 10 as of October 2013. For reports I see what you mean. Thank you

    • Linda J. Pigue

      Agree with you again Vicki. I think I-10 is overrated with regards to diagnosis coding. I-10 procedural coding is more challenging because of the specificity that occurs, in which does not occur with I-9. However, an experienced coder, while working with the doctor should be able to pinpoint the description, leading to identifying the most accurate procedural code.

  4. Productivity will be impacted in the HIM department as it is with any other type of change in any department. I can see no benefit in either of those scenarios. Healthcare organizations have already had expenses with EHR, new software, modifications to legacy software etc to accommodate the regulatory changes. Additional expenses for utilizing coders in this manner would not be something that I think would be approved at the C level.

    Gems mapping is a beginning of determining what I-10 codes may be used and incorporated into the system files. If non specific I-9 codes were used, non specific I-10’s will be the result. There is plenty of work to do just on the mapping and migration work. Remember, there is not a ‘standard’ or crosswalk of codes from I-9 to I-10, which leaves room for variability for each payer and provider. Will this ensure revenue neutrality?

    ICD 9 codes are outdated and will not be accepted after Oct 2013. They will not be useful statistically in the future for research or anything else so what would be the purpose? Auditing, clinical documentation review, education and contract review would be a better use for additional staff then double coding or dual coding.

  5. Indeed, which providers with current or future contracts impacted by ICD codes (which means many providers) wouldn’t put themselves into a better negotiating position by starting to “double code” their services? So as to better understand the services they provide and negotiate more accurate contracts with their payers? I’m not suggesting all providers need to start double coding everything indefinitely – just start to sample and understand differences and potential differences between their current I-9 stats and their soon to arrive I-10 indications.

    Indeed double-coding is an added expense; albeit an expense that may not be as large as one may believe. More and more vendors have products to assist with this and consulting service providers are starting to understand how they can assist. Recall the old saying: “Pay me now or pay me later?” Providers don’t have to incur a large expense to double code and better understand where their typical services are targeted. Is it not true that a lot of providers services are targeted at a somewhat limited, number of categorized diagnoses groups?

    Just a thought…not saying this applies to everyone but something most should consider..

    ShimCode on Twitter

    Also, I posted about the value of this topic a while ago: Financial Neutraility

  6. I think most providers would prefer to only Dual Code as Andy points out, but my coding collegues tell me I have to Double Code because the encoder is so different that I can’t code in ICD-10 and use the map to ICD-9, and manually disintermediate any imperfect mappings. Part of why the coders say this is because the 3M encoder has engineered it this way, as two totally separate logics. Two separate encoders that are very different. Was this need to double code with 3M’s tools intentionally or just sort of a byproduct of the software development cycle? Will 3M provide any enhanced Crosswalks to help providers save time so we don’t have to Double code?

    • In response to Tim’s statement, I think there is come confusion with dual coding and understanding its purpose. For the most part, medical providers should not be too challenge the new code set. Why? because, medical providers only need to give attention to ICD-10-CM only that is specific to their specialty. I have a draft ICD-10 book and the codes are easy to map, provides much details. In truth, I think the physician environment would love the new code set. There is no need to purchase a CAC. The purpose of encoder is to ensure the DxCPT/Modifer/HCPCS are in congruent. On the other hand, facility are challenged with code mapping because of the applicable new code sets (ICD-10-CM and ICD-10-PCS). In reference to dual coding, that is relevant with documentation.

    • Thank you for your comment. I’ve responded to your questions in a blog posted today: ICD-10: Dual Coding vs. Double Coding Part 2 (http://ow.ly/nMNk7). I hope this post gives you some answers, but as always feel free to comment with any additional questions.

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