Nena ScottOn Oct. 1, 2017, healthcare finance executives will have completed two years under the ICD-10 coding system. Now is a good time for them to take stock of where their organizations stand with respect to ICD-10 by considering three important revenue cycle questions:

  • Where is coder performance?
  • What have we learned?
  • Where are we headed, and what opportunities do we have for improvement?

Productivity and Accuracy

Nationwide, hospitals report a 20 to 25 percent dip in coder productivity since the implementation of ICD-10, a better performance than predicted. However, productivity levels may never return to those of ICD-9; the past six to nine months have seen a leveling off.

Results are likewise mixed from an accuracy perspective. Self-reported accuracy falls within 10 to 20 percentage points of ICD-9 benchmarks. However, quantitative coder accuracy studies report much lower code quality.

Quarterly or even monthly audits aimed at improving accuracy have become best practice under ICD-10. Frequent coding audits reveal areas of concern earlier in the process so that corrective and educational action can be quickly implemented. Audits also help build coding consistency, develop coders, and ensure compliance with coding guidelines.

Two Common Errors to Watch

One of the most frequent errors in ICD-10 coding is linked diagnosis. Most coders were trained in ICD-9 to assign separate codes for related diagnoses unless physician documentation noted the connections. However, under ICD-10, coders need no such documentation; they can link a variety of diseases by determining the “cause and effect” on their own. Hypertension and diabetes are common conditions reflecting these linked diagnoses.

ICD-10 surgical coding (ICD-10 PCS) presents a format that’s totally different from its predecessor. Coders require additional education to better understand the objectives of surgical procedures so they can code them correctly.

Staffing Trends

It was initially predicted that many experienced ICD-9 coders would leave the industry or retire before ICD-10 implementation. In reality, the majority of experienced coders have chosen to remain with the industry and take advantage of ICD-10 career opportunities.

Many new coders also have joined the industry to take advantage of the employment options and the need for increased staffing following the productivity slump. Thus far, these new ICD-10 coders have proven just as productive as the coders who gained their experience under ICD-9.

Employers should continue to provide effective training to enhance the speed and accuracy of OCD-10 coding. Training on electronic health record navigation helps improve productivity. A coder needs to know exactly where to go in the software to find the details required for coding accuracy. Productivity goes down when coders must slow their pace and dig deeper into multiple screens to find what they need.

Onward and Upward

The financial success of any healthcare organization depends on the committed efforts of productive and accurate coders, engaged clinical providers, and dedicated billing and coding managers. To provide these individuals with the support they need to excel in their duties, the healthcare organizations must seek to continually improve communication, while offering ongoing education and training and implementing more frequent coding audits. Such efforts are critical to increasing productivity, improving accuracy, and retaining experienced coding staff. 


Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS, is an AHIMA-approved trainer for ICD-10 CM and PCS and director of coding quality and professional development for TrustHCS Healthcare Consulting Services, Guntown, Miss.

Publication Date: Wednesday, April 26, 2017