Effects of ICD-10 on Coding Productivity

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In the years leading up to ICD-10-CM/PCS implementation, doomsdayers chanted horror stories of expected productivity losses of up to 50 percent. Now that we are nearly six months post-implementation, I’ve yet to hear about an instance where such a prediction came true. In fact, I’ve heard over and over that productivity levels are almost at the same level in ICD-10 as they were in ICD-9. This is especially true in facilities that had robust training and dual/double coding in place leading up to the implementation date. These coding professionals were able to easily make the transition from ICD-9 to ICD-10.

So what can you do if your coding productivity is being negatively affected by the implementation of ICD-10? First off, the coding manager/director should have discussions with their staff regarding any areas that are challenging. Is the staff struggling with the nuances of ICD-10-CM or is it the procedure codes (ICD-10-PCS) that are causing the most difficulty? Focused training on the challenging areas may be needed to assist the coding professionals.

Another potential slowdown in productivity could come from incomplete documentation and the need for the coding professionals to have to dig deeper into the health record to find the level of detail they need to accurately assign the ICD-10 codes. If this is the case, then there may need to be education for the physicians on documentation needs. If your facility has a CDI program, this is where they will come in to educate the physicians on the nuances of ICD-10 and the need for more complete and accurate documentation. The physician query forms should have been updated for ICD-10 needs, and this is a great form of education to inform the physician of what type of verbiage is needed to accurately assign a code.

Now I’d like to hear from my readers out there. Please comment on this blog and let us know how ICD-10 has affected your productivity. Any great tips you’d like to share?

Melanie Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, FAHIMA, is senior director of HIM practice excellence, coding and CDI products development at AHIMA. She has over 15 years experience in HIM and coding, with her most recent focus being in ICD-10-CM/PCS, and has presented numerous times at the regional, state, and national levels on HIM and coding topics. She was previously a director of HIM practice excellence, focusing on coding products, resources, and education, at AHIMA. Melanie is an AHIMA-approved ICD-10-CM/PCS trainer and an ICD-10 Ambassador.

9 Comments

    • Hi Sandy,

      By L codes, do you mean the HCPCS Level II codes for Orthotics and Prosthetics? If so, these are not part of the ICD-10-CM or ICD-10-PCS code sets. If you have a specific question about the correct application of these codes, I would suggest posting a question to the AHIMA Engage site for Coding, Classification and Reimbursement, which is found at this link: http://engage.ahima.org. This a great venue to use to discuss important issue with numerous other coding professionals.

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  1. We are not back to ICD9 levels, particularly in ASU/IP. I’m also seeing a fair amount of articles talking about the struggles others are having. It’s not 50% but there is definitely an impact.

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    • Thanks for your comment, Jean. How is your organization dealing with this drop in productivity? Are you hiring contract coders? Mandatory overtime?

      Also, I’m curious if you’ve decreased the productivity standards now that ICD-10 has been implemented?

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  2. Hello Melanie,

    We are still not at the ICD-9 productivity level. A lot of our productivity issues is due to documentation and digging for further specificity. I believe with physician education, this shall improve. Will AHIMA be providing some type of sample productivity standards for ICD-10? They provided sample productivity benchmarks back on 2005. It was a good reference for us. I have lowered my productivity but will appreciate guidance from AHIMA. Any thoughts? Thanks in advance for your assistance!

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  3. In outpatient coding, we have seen slight decrease in productivity in day surgery and observation cases. For other outpatient classes, not much impact. Inpatient, we have seen statistically significant drop from average slightly more than three charts/hour to 2.15 charts per hour January and February 2016. We had assessed Coder productivity during dual coding period in 2015 and for fourth quarter 2016 to see what we could really do, and have adjusted our productivity standards and bonus programs accordingly. We have backfilled with contract staff to make up the difference, and have budgeted for and posted several permanent positions. CDI and Corporate Coder Education programs are in place and provide feedback and updates every week. Our focus for 2016 is getting the coding right, with expectation that productivity will rise with more exposure and timely feedback.

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  4. As an inpatient coder, we are seeing a decrease in productivity. It’s hard to say how much of a decrease because our productivity isn’t calculated correctly and has been an ongoing battle for many years. Does anyone have suggestions on how to calculate productivity?

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  5. We have seen the most impact on emergency coding. The rest of our services quickly recovered to pre-ICD-10 standards. Do you know of any update date info or articles on current benchmarks for ICD-10 productivity standards?

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  6. Really useful information. Thanks for the info, super helpful. I’ve found some decent tutorials on how to fill UK EEA4 out online here http://goo.gl/Au2FwG .

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