For the past year, medical coders at Children’s Hospitals and Clinics of Minnesota have been pulling double duty or, more aptly, dual duty.

In anticipation of the change to ICD-10 later this year, coders have been logging inpatient and clinic cases in both ICD-9 and ICD-10 codes.

“In addition to dual-coding cases for payer testing, we also dual code for internal analysis to better understand potential DRG shift,” says Jeff Young, chief information officer at the Twin Cities-based health system. “Our primary goal has always been to give our coding staff practice to improve their skills. It is particularly critical for our inpatient and ambulatory surgery coders to develop their skills with ICD-10’s procedural coding system, which is very challenging.”

It is hard to ascertain exactly how many health systems are dual coding, but Cindy Nichols, senior vice president for health information management at Parallon, suggests that nearly half of the firm’s clients are engaged in the practice. Beyond helping coders become more familiar with ICD-10, Nichols says there is a benefit in being able to discover any documentation gaps and knowing when coders will have to go back to physicians for more detail.

Dual coding isn’t without challenges though, namely in resources and productivity.

“Some clients are seeing productivity go from 100 percent on ICD-9 to maybe 30 percent when they take on dual coding,” Nichols says. “It is purely a resource constraint.”

Health systems heading down the path of dual coding should take a few things into consideration, suggests Nelly Leon-Chisen, director of coding and classification at the American Hospital Association. Obviously, the resource issue is the first thing to tackle. Every coder can’t dual code every case, she says. Additionally, there needs to be some oversight to ensure that coders are getting a grasp of the ICD-10 codes.

At Children’s Hospitals and Clinics, inpatient coders started off last fall dual coding two days a week; clinic coders did 10 cases per week. As of April, 100 percent of inpatient cases are being dual coded. Clinics are on track to hit that mark this month.

Ultimately, Young expects dual coding to pay off for the organization.

“Our revenue stream is dependent on a successful transition,” he says. “We need to be fully prepared and minimize risk for this monumental change.”


Jeff Young, CIO at Children's Hospitals and Clinics of Minnesota, suggest that these action items are critical to a successful migration to ICD-10:

  • Dual coding
  • Testing with payers
  • Analyzing data to understand what DRG shifts you'll encounter
  • Preparing data analysts for reporting using ICD-10
  • Contracting with payers to ensure budget neutrality if possible
  • Ensuring adequate resources for the coding team
  • Education physicians on the need for specificity in documention
  • Providing physician offices with access to coding summaries