Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

Coding Productivity Fell by 14% After ICD-10 Implementation

A recent survey reported that overall healthcare coding productivity and accuracy has decreased after ICD-10 implementation in October.

By Jacqueline LaPointe

- As the anniversary of ICD-10 implementation approaches, a survey from the American Health Information Management Association (AHIMA) Foundation has revealed that coding productivity and accuracy has marginally declined since ICD-10 began.

Coding productivity and accuracy rates fell after ICD-10 implementation

“Health information management (HIM) professionals are already coding with the same degree of accuracy as in ICD-9,” said Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA, AHIMA’s CEO.

“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.”

According to the survey results, participants reported a 14.15 percent decrease in overall productivity and only a 0.65 percent decrease in overall accuracy among coding specialists.

Out of those who responded to the study, about 68 percent experienced a decrease in productivity while 5.8 percent noted an increase and 26.3 percent had no change. In terms of accuracy, most respondents reported no change in accuracy (61.5 percent), about 30 percent noted a decrease, and 26.9 percent saw an increase.

While most participants faced some challenges with ICD-10 implementation, most healthcare stakeholders expected a decrease in productivity and accuracy due to unfamiliar changes to coding systems.

“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, AHIMA Foundation’s research manager.

When researchers set out to discover why some coding specialists saw negative impacts with ICD-10 implementation, they revealed that organizations that used computer-assisted programs had more of a decrease in productivity.

Those with a computer-assisted coding programs faced a 17.1 percent reduction in overall productivity, equating to 5.18 percent more of a decrease than respondents without the program.

However, participants with the coding programs experienced a 0.2 percent increase in overall accuracy, while those without the programs noted a 1.58 percent decrease.

“When we break down the analysis, we see that initial discrepancies seem to be based on the fact that a higher percentage of CAC [computer-assisted coding] use occurs in inpatient settings that have higher levels in decreased productivity with CACs,” stated the survey. “When controlling for setting (in-patient/outpatient), differences do not exist in rates in the use of CAC when coding records.”

Researchers also explained that the introduction of computer-assisted coding programs usually coincided with the start of ICD-10 implementation, which may have caused greater decreases in productivity since many coding specialists were learning to use the new programs.

Looking closer at differences in rates, researchers found that levels of coding experience largely affected productivity.  Participants with one to five years of coding experience reported the lowest level of decreased productivity at 19.97 percent, while respondents with six to ten years of experience faced a 27.17 percent reduction.

Level of education also factored into coding productivity, explained researchers. The survey showed that those with graduate degrees actually experienced more challenges with productivity, representing a 25.6 percent decrease, whereas those with bachelor degrees only had a 7.62 percent reduction.

Before ICD-10 implementation went into effect, a 2014 AHIMA and eHealth Initiative survey found that most healthcare organizations were concerned about drops in healthcare revenue cycle and coding productivity. About one-third of providers expected a decrease in revenue after ICD-10 and 59 percent anticipated slower, more difficult claims processing.

While the most recent survey confirmed that some concerns with ICD-10 implementation were accurate, AHIMA researchers predict that decreases in coding productivity and accuracy are temporary. Once organizations become more familiar with ICD-10 and new coding programs, these levels may stabilize.

However, healthcare stakeholders may be facing some more challenges with ICD-10 implementation. CMS recently announced several updates to the ICD-10 system, which are scheduled to launch in October, including the addition of 5,500 new codes. The update comes after a freeze on adding new codes to ICD-10.

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