The State of Coding

It's hard to imagine that it's been more than a year since ICD-10 implementation finally happened. Even with comprehensive training in place prior to the new set of 68,000 codes, coders haven't seen an improvement in productivity.

Per a report by The American Health Information Management Association Foundation (AHIMA), coding productivity has stabilized, with providers seeing a 10-15 percent decrease since ICD-10 implementation. This doesn't mean providers can take it easy, as there are still lingering issues in the future that will affect coders, such as the 260 new diabetes combination codes formulated for reporting manifestations and 3,651 inpatient procedure codes for 2017.

In the same AHIMA Foundation report, I found it interesting that new coders, those with 1-5 years of coding experience, were the most productive. Meanwhile, those with 6-10 years of experience found their productivity levels decrease. These new codes and their new edits caused a breakdown in the workflow with seasoned coders because a complete rewiring had to happen to code to the highest level of specificity. For example, "A" as the seventh digit presented challenges, even among providers, as it meant the initial visit for the injury and any subsequent treatment wasn't in the recovery/healing stage ("D") or the sequela stage ("S"). That type of research takes time. 

In the grace period that expired Oct. 1, 2016, it states that if providers use an unspecified ICD-10 code-one that typically ends with the numeric digit nine and has a bold notation, when a more appropriate one is available-they risk receiving claim denials. This can lead to a halt in reimbursement for providers and result in a loss of time and staff resources.

ICD-10 is still a work in progress as exemplified in the Centers for Medicare and Medicaid Services announcement last week. The organization stated it will not apply penalties to affected practices that were involved with the ICD-10 coding mix-up that potentially led to unfairly applied physician penalties under the Physician Quality Reporting System (PQRS).

It will be interesting to see if the levels of productivity will ever revert to the levels they were pre-ICD-10, especially with the increase of Computer Assisted Coding (CAC) system software and the push for better analytics. Coders can become more productive with monthly education for increasing denial awareness and edits, more training on what is expected in documentation and follow-ups on the quality of the EMR/EHR.

Even with the lower productivity levels, I believe we're already seeing the new codes providing better data and enabling better health comparisons across the world.

Providers also are becoming more productive. Physician champions have helped them improve their documentation, resulting in fewer queries and increasing the likelihood of getting it right and out the door correctly the first time. On the facility side, clinical documentation specialists assist the coders and doctors with their findings, and they work as a team for a smoother process with fewer denials.

More than ever before, the quality of documentation is linked closely to reimbursement. The more structured the data, the less confusion there is over creating clinical documentation for the necessary data to code correctly. With the key role coders give to healthcare providers in obtaining payment from insurers, it's no wonder why there's still a nationwide demand-according to the Bureau of Labor Statistics, employers are expected to add 29,000 new medical coding jobs over the next decade-for the profession.

Diane Rivers, BA, CPC, NCICS, Certified ICD-10 CM & PCS Trainer, AAPC Fellow, is a member of the IT Professional Services Team at CSI Healthcare. For more information on coding, please contact her at