Survey: Coding Productivity Dipped After ICD-10 Implementation

The implementation of ICD-10 did result in a perceived loss of coding productivity, with a minimal dip in coding accuracy, according to a recent coding productivity and accuracy survey. The survey was conducted by the AHIMA Foundation in the first three weeks of May, and was released today, June 13.

Investigators from the Foundation sought to determine whether the implementation of ICD-10 increased, decreased, or had no change on the productivity and accuracy of coding professionals. The survey contained 13 questions pertaining to respondent demographics (level of education, years of experience in the field), type of facility at which the respondent is currently employed, and the perceived impact of the ICD-10 implementation on coding productivity and accuracy. In total, investigators sampled 438 coding professionals and received responses from 156 individuals.

Laptop with medical software and stethoscopeAccording to the survey results, overall, respondents noted they experienced a 14.15 percent decrease in productivity, yet only a 0.65 percent decrease in accuracy. Of those who responded, 67.9 percent noted a decrease in productivity, 5.8 percent noted an increase in productivity, and 26.3 percent noted no change in productivity. In terms of accuracy, only 26.9 percent saw a decrease in accuracy, 11.5 percent an increase in accuracy, and 61.5 percent no change in accuracy.

“Health information management (HIM) professionals are already coding with the same degree of accuracy as in ICD-9,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA. “Of course with any change there will be an initial period of productivity decline, but we fully expect this decrease will be short-term in nature. In fact, respondents indicated in the survey that they have become more comfortable with the new code set with each day and productivity decreases continue to lessen.”

A Closer Look at Productivity Rates

Members of the Foundation who worked on the survey told the Journal that the decrease in coding productivity was in line with what they were expecting to see.

“We anticipated seeing a dip, but were glad to hear from folks that while they did have an initial large dip it is now settling back to pre-ICD-10 levels, though slowly,” said Kate Jackson, RHIA, the Foundation’s research manager.

One interesting finding in the survey is how the level of coding experience impacted productivity. According to the results, those with one to five years of experience encountered the lowest levels of decreased productivity, while those with between 6 and 10 years of experience had the highest levels of decrease (19.97 percent and 27.14 percent, respectively).

Somewhat surprisingly, the level of education of coding professionals appeared to have little impact on coding productivity. According to the results, those with bachelor degrees had the lowest level of reported decreased accuracy, while those holding graduate degrees had the highest level of decreased accuracy (7.62 percent and 25.6 percent respectively).

Accuracy Rate Breakdown

For the most part, the implementation of ICD-10 had a very limited impact on coding accuracy, starting with the fact that only 26 percent of respondents noted a decrease in accuracy and 11 percent saw accuracy increase.

But investigators were quick to note that findings concerning the use of computer-assisted coding (CAC) programs had surprising results for productivity and accuracy. According to the survey, those who coded with a CAC experienced a 17.1 percent decrease in productivity overall, while those who did not experienced on average an 11.92 percent decrease in productivity overall. What’s more, those who use a CAC to code experienced a 0.2 percent increase in accuracy and those who did not noted a 1.58 percent decrease in overall accuracy. The report authors point out that this seems counterintuitive.

“To better understand why this difference occurred, we examined the difference in productivity and accuracy for inpatient and outpatient coding. When we break down the analysis, we see that initial discrepancies seem to be based on the fact that a higher percentage of CAC use occurs in inpatient settings that have higher levels in decreased productivity with CACs. When controlling for setting (in-patient/outpatient), differences do not exist in rates in the use of CAC when coding records,” they note.

Investigators suggest a need for further research to:

  1. Find out whether or not levels of productivity will revert to pre-ICD-10 levels
  2. Investigate whether productivity and accuracy levels will increase as the use of CACs become more ingrained into the coder workflow
  3. Provide more clarity in defining accuracy

Click here to register to download a copy of the full report.

 

Mary Butler is the associate editor at The Journal of AHIMA.

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16 Comments

  1. You obviously did not ask the coding supervisors, coding managers, quality team, and coding auditors to substantiate any of these results. The survey is also performed six months out from implementation. I can tell you, being a coder with 14 yrs experience, I code inpatients using CAC at a large trauma 1, University hospital and I most definitely lost productivity and procedure coding accuracy. According to the facility auditors, we all did. My productivity was cut by a quarter at least.
    You did the coding profession a great disservice by performing such a low-quality survey. You should not have based it solely on respondant’s answers. Talk is cheap. Really investigate, methodically – contact coding quality and auditors. Unfortunately, I believe this was just an opportunity for AHIMA to take a piss-poor survey with inaccurate results to substantiate I-10 success. We all know I-10 is successful & it was desperately needed….just don’t forget, it is us, the actual coding world & revenue cycle in general that has made it the success it is. It has been very hard work, my company started our mandatory I-10 training back on 1/1/12. I-10 is still revolving, we shall see what is in store October 1st.

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    • The reason for decreased productivity among the most experienced and educated is that in most hospitals they are doing the most difficult charts . Less experienced less educated people are assigned to easier cases or the OB newborn cases . I don’t find this surprising at all .

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    • Thank you for your feedback and comments. This survey was the initial phase to gain a baseline understanding of coding professionals’ perceptions of the impact of ICD-10 implementation on their productivity and accuracy. Future phases will examine additional areas and approaches, and will also seek to further expand the sample size.

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  2. I took the survey yesterday and was able to get a copy of the full report. I tried to access it multiple times today to get a second copy and I get a message that says I have already taken the survey. How can I get another copy of the survey?

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    • It should be possible to clear your web browser’s history and then complete the report access survey again. You can also save the PDF report to allow you to read it later.

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  3. My facility has also seen a decrease in production. The most significant decrease is in the outpatient areas. Because most of my coding staff has been doing so for more than 10 years, most of their diagnostic codes were memorized. They very infrequently used the encoder to arrive at a code. Now that everyone is forced to use the encoder/CAC or other tool to arrive at an ICD10CM or PCS code, production has taken a nose dive! My IP is at 25% production loss while my OP is more in the area of 30-35% loss in production.

    I agree that a larger sample should have been sought out. I’m hoping that my CFO doesn’t see the results of this survey or I’ll be called to the table for some answers.

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    • Thank you for your feedback and comments. According to perceptions reported by the 168 respondents of a recent AHIMA Foundation study, coding productivity has decreased an average of 14.15%. Those in an inpatient setting who noted a decrease in coding productivity (86 respondents) reported an average decrease of 24.30%, while those in the outpatient setting (20 respondents) indicated an average decrease of 22.10%.

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  4. I totally agree with Sarah, they need to do a detailed, deep dive into the actual reports, not just using the information or numbers provided on a survey! They need to get the real numbers, most everyone I have spoken to has admitted to at least a 25% drop in IP coding and a 30-35% in OP coding, these numbers given on this article are ridiculous! I do agree that those of us with the longer seniority who had mostly memorized everything, have had to do a total 180 degree shift. Ignoring huge amounts of data we knew for even larger amounts of data that we cannot possibly memorize! Going from being able to code a record from memory without using the logic or the book for the most part in a very short amount of time to having to look up each and every code and read all the edits and hints has added considerable time to my coding as well as auditing! Auditing has gone from just being able to look at the chosen codes to having to verify each one is exhausting and for myself somewhat depressing. I feel like I have lost something. I know we needed to change to I-10 very badly, even 20 years ago, but I mourn the loss of I-9 tremendously!

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    • Thank you for your feedback and comments. According to perceptions reported by the 168 respondents of a recent AHIMA Foundation study, coding productivity has decreased an average of 14.15%. Those in an inpatient setting who noted a decrease in coding productivity (86 respondents) reported an average decrease of 24.30%, while those in the outpatient setting (20 respondents) indicated an average decrease of 22.10%.

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  5. There has certainly been a decrease in production. Who ever took the time to write and gather survey results did not get their information from coding production reports. Upper management at my facility still has the idea that nothing has changed dignify it they are not the ones doing the work nor do they take the time to ask the coders, auditors, and coding supervisor/managers.

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    • I totally agree. Our VPs only look at reports and expect the team to do what they did with ICD-9 – while not having the tools they need to do the job correctly. Expectations are ridiculous and those doing the work cannot make their productivity and accuracy standards with little to no assistance.

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    • Thank you for your feedback and comments. This survey was the initial phase to gain a baseline understanding of coding professionals’ perceptions of the impact of ICD-10 implementation on their productivity and accuracy. Future phases will examine additional areas and approaches, and will also seek to further expand the sample size.

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  6. I have been in the profession for over 40 years and have seen a lot of changes. I have worked the past several years in RCS and for Denial Management.Our denial rate is very high on the outpt side and the inpt denials are ridiculous. ICD-10 has given the payers extra fuel to denial claims and keep their monies. Just another game to be played and it’s really frustrating when even the feds didn’t implement their correct editing software in time for the switch over. I have payers that are still lagging behind in their policy updates or denying claims now because of the new encounter codes. Some are denied because of edits resulting from the age related codes, ie age doesn’t match age of patient ( error message particularly from Medicaid. To make the matters worse our physicians are still documenting using the same old verbiage and we are spending a tremendous amount of time querying the docs. Lets talk about how that impacts AR and the days in holding!!!! I am ready to retire.

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  7. I have read through this chain of comments, my question is totally different. I work for a company that did not supply an encoder or any references that were easy to locate and search. Our team has struggled immensely not only trying to learn the new coding system but not having resources needed to find coding rules and Coding Clinics that pertain to ICD-10. Did your study address the lack of resources? Did your study address the lack of training supplied or approved to attend? Somehow I don’t think so. We have seen a 30% dip in productivity and probably a 15% to 20% dip in accuracy due to this. I am curious if this was even thought about. I can see credentials and years experience coding – but what about the actual ICD-10 education that was given or obtained? It is not an easy transition without the tools needed to actually code or even audit your team.

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    • Thank you for your feedback and comments. This survey was the initial phase to gain a baseline understanding of coding professionals’ perceptions of the impact of ICD-10 implementation on their productivity and accuracy. The use of encoders and CAC technologies was reviewed, though only briefly. Future phases will examine additional areas such as level of training and additional resources.

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  8. I think looking at these numbers (In total, investigators sampled 438 coding professionals and received responses from 156 individuals) these are the results are the response of 156 individuals. My concern about a survey this early in ICD-10 is that the lack of cooperation as hospitals struggle to manage the changes in production and quality. The effort is appreciated, but I would conclude these results are premature especially for production. By the way if your going to complain about these surveys why not volunteer with AHIMA to help out that is the way to respond.

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