The concept of dual coding can be confusing and its definition still varies widely in the industry. I recently received a comment on my blog, “1CD-10 and Dual Coding vs. Double Coding,” from 2011. The commenter spoke about his organization’s experience with coding in both code sets, stating that coders had been instructed to double code in order to maintain accurate coding in both ICD-10 and ICD-9. He noted that this created a time-consuming, redundant process and asked if the need to double code with 3M’s coding software was done intentionally and did 3M have any plans for enhancements that would save time in the future.
We usually don’t get into product details on our blog, but since other readers may have the same questions I want to use this blog post to look at dual coding again and give some answers on our approach to dual coding. The following will detail 3M’s dual coding strategy and how it can help reduce the productivity impact expected with ICD-10.
First, as the commenter notes, the 3M Coding and Reimbursement System (CRS) has two “native” methods for coding, one for ICD-9 and one for ICD-10. The ICD-9 logic-based keyword paths have been used, enhanced, and modified since the inception of the 3M software in the early 1980s and that is why the 3M logic, partnered with the coder’s expertise, derives an accurate, complete, and compliant set of codes for a medical record. We have now built a “native” method for ICD-10 due to the differences between the two code sets. This work had to be done from the ground up because we wanted to ensure that we could accurately produce an ICD-10 code based on ICD-10 guidelines and specificity.
However, coders aren’t limited to coding natively in both code sets (i.e., double coding) in order to collect both code sets for the time before and after the October 1, 2014 implementation date. We set out to create several different tools that would allow providers to choose how they wanted to collect both code sets on records. Here are the methods available in 3M CRS today:
1. A coder can natively code in ICD-9 and then start over and natively code in ICD-10.
2. A coder can natively code in ICD-9 and use a translation tool to identify ICD-10 codes.
3. A coder, using a single logic pathway, can derive ICD-10 and ICD-9 codes simultaneously.
NOTE: The following workflow is relevant when using the keyword logic-driven pathways within the 3M coding system.
Let’s look at an example of the keyword logic-driven pathways within 3M CRS for method #1 (natively coding in both ICD-9 and ICD-10) for Congestive Heart Failure (CHF). A coder enters CHF at the ICD-9 Keyword entry prompt and makes seven selections to arrive at the following ICD-9-CM diagnosis and procedure codes:
Now let’s look at the same Congestive Heart Failure example for method #3 (using a single logic pathway to derive ICD-10 and ICD-9 codes simultaneously). With the system enabled for dual coding, a coder enters CHF at the ICD-10 keyword prompt and makes nine selections to get to the following codes:
Using 3M’s method of dual coding reduced the prompts from 15 when coding natively in each code set to nine prompts when using a single pathway to derive both codes simultaneously. This model allows for accurate, complete, and compliant coding in both ICD-10 and ICD-9, while improving productivity as the coder does not have to switch to a different code set and start over. Not all coding scenarios will have this type of productivity improvement due to the differences in the code sets, but 3M CRS looks for these opportunities when it does not risk the accuracy of the ICD-9 coding output.
I appreciate the comments on this blog and I look forward to sharing any other insights I can as we learn together and as the ICD-10 transition date gets closer.