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ICD-10 and DSM-5: Changing organizational culture and habits

June 30, 2014
by Lisette Wright
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As I continue to teach the tedious details of the ICD-10 and DSM-5 coding systems, I find myself asking, “How in the world are administrators going to get their clinicians to do all this work?” After all, the ultimate responsibility for the medical record and its diagnostic contents rests with the clinician who assigns the diagnosis (unless you have coders). Changing the culture of an organization, and the mind-sets of clinicians and staff at all levels, is not to be underestimated. Indeed, the entire notion of coding, documenting, and diagnosing to the greatest detail possible in the ICD-10 is going to present everyone with a challenge.

Recently, I heard from an organization that the medical records and coding departments were quite excited about learning my curriculum while the clinical and administrative areas were less enthusiastic. I imagine the coders were saying, “Finally! More specificity which means easier coding, and no more NOS!” And, I hear the other side of the room saying, “What? Take away my favorite NOS diagnosis? What? I have to write more stuff down in the chart?”

Peter Block’s theory of change management emphasizes “the general school of thought is that the most-effective and longest-lasting change is achieved through a behavioral norm-based strategy, with effectiveness decreasing with incentive-based, sanction-based, and adoption-based strategies.” The notion here is to work side by side with those who will bear the greatest burden of change with the ICD-10: the clinicians. Finding ways of integrating the least possible disruption into their workflows, whether or not you have an EHR, will require a collaborative approach by everyone. As some of my organizational clients know, I put the psychiatrists and the coders in the same training class. Why? Everyone needs to learn the new way of the ICD-10 and the new coding/documentation rules.

The most important aspect of the ICD-10 change is the culture of the organization to adapt to a new way of doing work. In order to work collaboratively with the clinicians and staff, everyone needs to understand the whole DSM-5/ICD-10 dilemma. This will require training, education, and practice. And more practice, with peer reviews for a feedback loop so that your staff can help each other learn the new code sets. Putting off understanding the code-sets, the applications, and learning new ways of documenting, only perpetuates entrenched “old habits.” The medical industry is struggling with the same sense of “We have over a year now, this can wait.” The point? It’s better to learn ICD-10, truly understand the impact and what it means, and get used to it rather than trying to change an entire organizational culture at the last minute.  By the way, you can have fun with this: just go to YouTube and look for the ICD-10 Code W61.92 by Find-A-Code Institute. Who said diagnosing and coding was boring?!


Lisette Wright

IT Consulting for Health and Human Services

Lisette Wright



Lisette Wright, M.A., LP has over 20 years of experience in the healthcare...

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