ICD-10 Training and Preparation- The Success Factor

The delay in implementation of the ICD-10 classification system is not likely to continue in 2015 with many associations including AHIMA and nearly 100 other physician driven associations offering their support of ICD-10 this time around. Forward thinking providers are beginning to ramp up their preparation and training plans that were put on hold in conjunction with the 2014 delay in implementation of ICD-10. These training plans vary from one-on-one education for physician to formal lectures by outside consultants and training on demand modules physicians can use on their own time schedules. While providers can be commended for engaging in preparation for the increased clinical specificity documentation requirements under the ICD-10 classification system, the question remains as to truly how effective these training programs will be in engaging physicians in real behavior modification in documentation patterns reflective of these ICD-10 requirements. Let’s examine the potential limitations of these common ICD-10 training plans and programs and the potential solutions

Potential Limitations of Traditional ICD-10 Training Efforts

There are several potential limitations of traditional ICD-10 training efforts as I have witnessed over the course of the last six months. The first relates to physician’s learning attention spans, no different than the majority of us, even more so with physicians. Formal lectures and presentations usually last between 45 minutes to an hour and personal experience has consistently shown that physicians begin to tune out within 15 to 20 minutes of the start of the training. This form of learning is static and lacks the incorporation of clinical context that the physician can relate to in terms of conceptualizing and understanding how enhanced clinical specificity in documentation directly impacts their business of the practice of medicine. Similar to the teachings and learning of principles introduced by the Pavlov’s dog experiment, reinforcement is the most effective form of learning that promotes behavioral modification and actual learning that will stand the test of time as opposed to “cursory learning.” Physicians learn bet through “doing” just like foundation of learning in medical residency programs. Formal lectures and presentations, while certainly offering physicians insight into the enhanced documentation opportunities ICD-10 offers for all the right reasons, will not change or significantly alter overall physician behavior patterns of documentation due this lack of reinforcement and engagement. Physician engagement in learning key principles of ICD-10 documentation specificity is not assured and furthered by lectures and other forms of presentations, whether they be live events or recorded events, particularly if these presentations are made mandatory by hospital administration or leadership in the medical staff. Physicians will think of themselves as willing/unwilling participants in learning which is distinctly different from engagement. Engagement implies physician recognition of the benefit and value of improved clinically specific documentation to their business of the practice of medicine.

A brief look at canned ICD-10 modules invokes the same concerns and limitations of limited, structured learning inherent to and pointed out above in the discussion of formal lectures and other presentations. There is no opportunity for the physician to ask clinically relevant questions and once again the physician is not necessarily able to conceptualize and relate to the covered material without reference to real clinical medicine scenarios. Physicians are even less so engaged in this type of learning, considering themselves participants simply going through the motion of listening to the modules as a matter of principle and responsibility as part of the medical staff.

Alternatives to Supplement and Complement Formal ICD-10 Training.

An effective physician ICD-10 training plan in preparation for the October 1, 2015 rollout of ICD-10 may include the above training and education formats supplemented and complemented by the following considerations in support of a greater likelihood of success in physician behavior modifications in general documentation patterns. First and foremost in engaging physicians is ascribing to the well-known principle of WIIFM, what is in it for me. How does the enhanced clinical specificity under ICD-10 truly benefit the physician today and tomorrow? Why should the physician take the time to learn about and remember to include clinical specificity in his/her documentation today and tomorrow? What purpose does enhanced clinical specificity have to the patients care today and tomorrow?

Clinical specificity in documentation best serves the effective communication of patient care, telling and retelling of the patient’s clinical story and serves as the basis and fundamental structure for numerous value/performance based healthcare delivery model transformation initiatives predicated on value versus simply volume of services provided. Clinical specificity in documentation helps to answer the following questions that are rudimentary to sound documentation principles:

  • Who?– Who is performing the service?
  • What?– What types of services are performed?
  • How many?- What are the quantities of services performed?
  • Where?- What is the place of service?
  • When?– When is date of service?
  • Why?Establishing medical necessity and diagnosis


Establishing medical necessity for all physician services provided and/or ordered assumes new meaning and relevance to physicians under new payment models currently in existence or being piloted such as accountable care organization, patient centered medical homes, comprehensive primary care initiatives, gain sharing, shared savings programs, bundled payment for care improvement initiatives, PQRS, Vale Performance Modifier Program, and Quality and Resource Utilization Reports to name just several. Effective documentation that shows and describes the complexity of patient care, the intensity of care congruent with the patient’s severity of illness reporting consisting of clinical specificity in diagnosis, is paramount for physician success under these new as well as piloted healthcare delivery models. Effective and  complete clinical documentation including diagnosis specificity is fundamental to accurate reporting of physician clinical judgment, medical decision making and thought processes as well as complexity of patient care, an important factor in describing and showing medical complexity driving appropriate physician E & M assignment and reimbursement. Most importantly effective and complete clinical documentation that incorporates clinical diagnostic specificity is just plain good medicine, furthering proper reporting of better patient care, better patient outcomes, better care coordination, better resource utilization management measures, better physician profiling and tiering, and better measures within the value=quality/costs equation.

Getting Started

Formal physician ICD-10 training can serve as a foundation for ICD-10 documentation preparation as long as the above noted points are incorporated into the training material and objectives. Clinical documentation improvement specialists play an integral role in reinforcing key principles of why clinical specificity is important today as well as tomorrow as part of their regular duties and responsibilities in affecting positive change in clinical documentation improvement through record review and identification of query opportunities. You will want to listen to a webinar I presented on March 11 titled “Engaging Physicians in True Documentation Improvement Today for ICD-10 Tomorrow, A Practical Approach “ that was recorded and may be found here at the end of the week of March 20th.