Health Information Management

Prepare now for ICD-10 coding productivity challenges

JustCoding News: Inpatient, June 6, 2012

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Many HIM directors and coding managers are aware of the decrease in productivity that is anticipated with the implementation of ICD-10.

That concern is a valid one, according to Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, chief operating officer of St. Louis-based First Class Solutions, Inc. Dunn presented the session "Coding Productivity: Preparation for ICD-10" March 1 at the JustCoding Virtual Summit: ICD-10-CM and ICD-10-PCS.

In ICD-9, coders are accustomed to using the numerical keypad for code entry because so few codes have an alphabetic character, but in ICD-10-CM, that's not the case, Dunn said. Consider the large  category of codes for pregnancy and childbirth.

"The codes in this category start with an alphabetical O, so for a split second, our coders-especially our experienced coders-will need to question to make sure they didn't enter a zero instead of an alphabetical O," she said. Coder similarly must be careful when reporting procedure codes, some of which begin with the number zero.

This might not sound like a significant problem, Dunn explained, but consider the advantage of the HIPAA 5010 transaction set.

"We're now able to enter 25 diagnoses and 25 procedures, whereas before we were limited to nine and six," she said. "So that split second adds up to seconds and minutes."

In addition, flipping between the numerical and alphabetic keypads takes additional time. "Just think about the time you spend entering a text message on your cell phone and the need to flip back and forth between the letters and the numbers," Dunn pointed out. Additionally, many of the codes will be longer in ICD-10, and some people are anticipating a greater number of queries as a result of the increased documentation needed under the new coding systems.

Predicted declines
The experience of Canadian healthcare organizations may be the best indicator of what's ahead in terms of productivity changes, Dunn said. Providers there experienced a six-month learning curve when they implemented ICD-10, which is the same length of time as HHS is predicting.

That said, given the longer time needed to enter codes and the potential increase in queries, Dunn doesn't believe coders will ever achieve today's level of productivity under ICD-10.
The 10 P's of ICD-10 coder productivity preparation

According to Dunn, the 10 P's of ICD-10 productivity preparation are:

  1. Capture a Point of reference
  2. Predict labor requirements
  3. Plan for sources of labor
  4. Product and tool considerations
  5. Take the Pulse on skill sets
  6. Polish the skill sets
  7. Prep coders, physicians, and others for ICD-10
  8. Practice ICD-10
  9. Adjust labor Predictions based on training and ¬practice results
  10. Be Poised for 10/1/2013?

Tips for minimizing the decreased productivity
Dunn provided the following tips for mitigating the expected decreases in productivity that will come with ICD-10 implementation:

  • Consider using coding assistants. These include clerical staff members who can help follow up on queries to reduce the double handling that coders currently do. This way coders only need to attend to an encounter when formulating a query and then when medical staff responds, she explained.
  • Eliminate non-coding duties. "We no longer have that luxury," Dunn explained. It may also be necessary to consider having other staff members enter the codes into the billing system or perform abstracting, she said.
  • Reduce distractions for coders-both in the office and off-site. Consider conducting spot visits for remote coders to ensure they are free from distractions while working off-site.
  • Take a look at technology needs. Optimize connectivity for off-site staff and consider dual or triple screens for coders. Don't overlook the advantages that computer-aided coding applications may provide.
  • Consider dual coding as soon as ICD-10 education is complete, and be sure to provide feedback to coders based on their dual coding performance.
  • Emphasize that coders must take responsibility for their own professional development. "The point should be that the organization will provide some support, but that each team member is expected to do some preparation on their own," Dunn said. Encourage team members to work with their colleagues and share what they learn.
  • Use skills assessments to identify weaknesses. This includes assessing coders prior to educational refresher courses, such as on anatomy and physiology, and again after they complete the courses. Conduct assessments yet again after detailed ICD-10 education occurs.
  • If your coders have strong stomachs and could use some education on different procedures and surgeries, consider taking advantage of the free videos available on YouTube.
  • Consider supplemental staffing options, including cross-training coders, or backfilling with contracted staff so coders can participate in educational activities. Implementing an apprentice system may also be an option for "growing your own." Consider nurses or therapists who, due to a physical injury, may no longer be able to perform their job but have all the bioscience skills necessary to learn how to code, Dunn said.

And remember, if problems exist today, they need to be fixed before getting to ICD-10, Dunn said.

This article was originally published in the May issue of Medical Records Briefing. Email your questions to Senior Managing Editor Andrea Kraynak, CPC, at

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