Health Information Management

Analyze potential effects ICD-10 will have on coder productivity

JustCoding News: Inpatient, December 9, 2009

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You’ve probably realized by now that there is no cookie cutter strategy to tackle the transition to ICD-10, which takes effect October 1, 2013. Assessing and preparing for the effects this will have on coder productivity is no exception.

“The impact will be huge at first,” says Rhonda Buckholtz, CPC, CPC-I, CGSC, COBGC, CPEDC, CENTC, vice president of business and member development at the American Academy of Professional Coders (AAPC) in Salt Lake City. “Since we will be transitioning to such a larger code set with far more selections, it will take coders longer to find codes.”

In addition, Buckholtz notes documentation hurdles (e.g., laterality, stages of healing, and trimesters) will also slow coders down.

Orthopedics and obstetrics/gynecology are two particular specialties that may be affected more than others because the majority of the most easily recognizable changes pertain to them, Buckholtz says.

“The impact will really depend on the type of provider,” says Mike Magliaro, MBA, MHA, vice president of National Healthcare Industry Practice Leader at TM Floyd & Company in Columbia, SC. “The effects on coder productivity probably won’t be as difficult for smaller practices, particularly for subspecialties or primary care. A big part of this is what technology do practices and hospitals use and how well will they document in the future.”

The effect on coder productivity may also depend on how the hospital is structured, says Caroline R. Piselli, MBA, RN, FACHE, ICD-10 program manager at 3M Health Information Systems in Salt Lake City.

“Some hospitals are structured by service line or specialty, so coders are trained to really know the ins and outs of those specialties. For these coders, learning ICD-10 can be focused and quicker,” Piselli says. “For coders with broader responsibilities, there’s more to learn across each functional area.”

Examine staffing needs

Facilities and practices may need to address staffing levels for the implementation period to ensure that the organization stays as current as possible with coding, not to mention denials management and claims resubmissions, Buckholtz says.

Larger integrated health systems and/or hospitals might hire additional staff members before the switch to ICD-10, but smaller facilities may not have the option to bring on more staff members and may have to work with current resources, Piselli says.

You don’t want to wait until after implementation in 2013 to assess your potential staffing needs, Magliaro says. “The problem you’re going to get into is resources. Realistically, figure that you’re going to have problems the first year,” he says. “So look for ways to supplement your staff for that first year.”

Assess the impact, devise a strategy and plan, and get funding for the resources necessary to carry out your strategy, Piselli says, noting that in an ICD-10 panel presentation she moderated at the American Health Information Management Association (AHIMA) convention in October, a panelist from a smaller hospital shared that her organization had brought on two additional coders this year as part of their overall ICD-10 strategy. This panelist said that many of the hospital’s patients are complex, so by bringing in additional coders now, the hospital could start working on concurrently capturing all the details necessary for their more complex patients, while also using this detailed information for clinical quality improvement, Piselli recounts.

Consider findings in AHIMA report

In September 2003, the AHIMA conducted a study titled, “ICD-10-CM Field Testing Project,” which examined the functionality of the application of ICD-10-CM to medical records in a variety of healthcare settings. The study involved coders with varying levels of competency and experience who practiced coding with ICD-10-CM, using only basic print and other educational materials as well as a manual (no software).

The report of findings stated the following:

The additional time needed to code records in ICD-10-CM as opposed to ICD-9-CM is not particularly problematic or indicative of any long-range implications for productivity after ICD-10-CM implementation. Taking longer to code with ICD-10-CM would be expected, given that participants received minimal training, were basically unfamiliar with the coding system and lacked user-friendly coding tools. 

“As with any change and associated learning curve, the productivity decreased somewhat initially, but within a short time frame, coders were back to where they were originally,” Piselli says.

The largest discrepancy between the amounts of time it took to code in ICD-9-CM versus ICD-10-CM was for behavioral health outpatient records—3.08 minutes to code using ICD-9-CM as opposed to 9.71 minutes using ICD-10-CM. The smallest discrepancy between the coding times for these two systems was for home health and hospice records—10.76 minutes using ICD-9-CM versus 13.31 minutes using ICD-10-CM.

Records for long-term care hospital inpatients took the longest to code—18.22 minutes in ICD-9-CM versus 28.74 minutes in ICD-10-CM.

So how should coder productivity expectations change after ICD-10 implementation?

“I think how well you prepare will determine the answer to that question. Looking at the examples overseas, some hospitals showed a doubling of accounts receivable days, which for most would be a killer,” Magliaro says. “In some cases, it took a long time, sometimes six to nine months or as much as a year to get back up to regular coder productivity levels.”

One clever strategy to help maintain productivity levels is to build in some incentive for those who play critical roles in completing claims once ICD-10 takes effect, Magliaro says. “Some hospitals are making the completeness of the data part of the performance review for both coders and clinicians.”

Improve documentation and knowledge of anatomy

Although many experts agree it’s too early for coders to learn the ICD-10-CM and ICD-10-PCS as these code sets may change several times prior to implementation in 2013, there are important steps you can take now to prepare your coding staff members.

“Now that we have this lead time, facilities have to think strategically about how they’re going to get from today to 2013,” says Piselli.

Even though there’s time to get coders up to speed on the new code set, it’s going to take more than a simple crash course a few weeks before the implementation date. For example, one ICD-9-CM code might crosswalk to 50 ICD-10-CM codes.

Coding with ICD-10 will require significantly more data capture, Magliaro says. “Coders need to know a lot more about medicine in general, anatomy, and physiology.”

It’s beneficial to work on the documentation piece of the puzzle now, Piselli says. She suggests providers begin considering what physicians will have to document and what details will be necessary to accurately assign ICD-10 codes.

“Determine what details need to be documented, and collaborate with physicians to determine the simplest process to enable getting these specifics in the record,” according to Piselli. With that said, physicians have their own clinical care and productivity issues, and HIM and coding professionals should keep that in mind regarding this education aspect. “I think it’s our job to make it as easy as possible for physicians and to support them as best as we can.”

Take a leadership role in implementation

HIM professionals should harness this opportunity to take the lead with the transition to ICD-10 and partner with their chief information, financial and clinical officers to ensure the whole organization is ready and takes advantage of the detailed information that ICD-10 will provide, Piselli says.

“First and foremost, get on board with executives, and form an interdisciplinary steering committee,” she says. “Make sure there’s a project plan for the entire hospital and integrate the plan with vendors, payers and others with critical interdependencies.”

Share your research with executives, and convey to them the importance of sticking to a structured timeline to ensure a smooth implementation. Give them an easy-to-understand framework for the steps you need to take as an organization, such as this chart from 3M Health Information Systems, “Ten Steps to Successful ICD-10 Implementation.”

One of the biggest hurdles in the implementation of ICD-10 is the tendency of some organizations to underestimate how far-reaching this transition will be. Consider other affected departments, such as those that rely on ICD-9-CM codes to generate quality reports, Magliaro says.

“The biggest tip would be to start education and awareness organization-wide so everyone really understands it’s not just a coding issue,” says Magliaro, citing that upper management for many organizations misunderstand the magnitude of this switch to ICD-10. “They don’t get that this is the biggest change in healthcare operations that the industry has ever seen,” he says.

Take advantage of time and resources

Once coders start using ICD-10, coder productivity should rise within several months, Buckholtz says. Using tools, such as the AAPC’s Code Translator, to help crosswalk ICD-9-CM to ICD-10-CM codes will help ease productivity slowdowns, she adds.

However, Magliaro cautions that the healthcare community should not rely on these crosswalks as a sole solution. “Payers and providers should be aware that crosswalks are useful tools for understanding the relationships between the ICD-9 codes and ICD-10 codes, but will not automatically remediate information systems databases and processes,” he says.

Some companies have made efforts to automate the code translation process, Piselli says, citing the 3M™ ICD-10 Code Translation Tool, which helps convert ICD-9 based applications to ICD-10.

“Initially there could be some down time, however an offensive preparation strategy could mitigate the impact and in fact we could return to the same coder productivity levels, if not better,” Piselli says.

“Take advantage of the time—this is the biggest lesson we’ve learned from our international customers,” Piselli says. “Come up with a detailed plan, assess where your gaps are, develop a project plan based on the gap analysis, and make sure you have executive buy-in. You’ll then be ready to take advantage of everything ICD-10 has to offer.”

Editor’s note: E-mail Buckholtz at

E-mail Piselli at

E-mail Magliaro at

Interested in learning more about ICD-10? Subscribe to ICD-10 Watch, a free, online forum for all matters related to ICD-10. Receive multiple updates each week, and access the latest ICD-10 news as well as tips from the experts for how to manage the transition to this new coding system.

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