D'Arcy Gue

Minimize the Decline in Coding Productivity Caused by ICD-10

November 6, 2014

ICD-10 3 Minute Read

In the last four posts in this series, we’ve talked about a number of ways to approach the problems of coding productivity under ICD-10. In this post,  I’d like to mention a handful of other strategies to address this monumental decline in coding productivity.

Eliminate Non Coding Work

In many coding shops, coders do additional work as part of the handling of a chart that isn’t actually coding. Since the coder is often the only user to touch a chart between discharge and billing, the coder is often asked to perform various other tasks as well, such as identifying physicians and other forms of data abstraction. Each of these tasks takes away from the core activity of coding. While it may be more efficient in terms of total time per chart for one person to do all of the chart activity, the abstraction tasks can be performed by a trained data entry person who is not a scarce resource in the post ICD-10 world.

Documenter Training

One of the activities that takes significant time from a coder is documenting queries to the physician or other documenter. If coders can’t find a specific piece of information they require for coding the chart, they will review the entire chart looking for that piece of data before querying the physician. As a result, time is spent reviewing the chart, drafting the query, reading the response to the query, and re-reading the chart and completing the coding.

An effect of training is that, once physicians understand the data elements required for coding, they are likely to put them in the same place on the chart every time, speeding the coder’s review. For both of these reasons, well-trained providers make for more efficient coders.

Resource Availability

For coders to work at their highest efficiency, they need quality reference tools. Because of the greater number of codes under ICD-10, the volume of this reference documentation will increase. HIM departments should evaluate electronic reference applications for coding use.  Many internet-based resources are available that provide the coder with code search tools that replace the paper codebooks as well as reference material on anatomy and physiology, and other coding guidance tools like Coding Clinic articles.   These tools are generally not free, but most are quite reasonably priced when compared to the purchase price of the equivalent paper-based resources.

Provide a Resource for Questions

For many hospital-based coders, the most common resource that they use when unsure about a coding question is other coders nearby. Immediately after the ICD-10 transition, however, the other coders are probably just as inexperienced with the new code set. Asking questions this way takes these coders away from their coding.

Hospitals should consider providing an official channel for coders to ask ICD-10 coding questions. By doing so, the hospital ensures that only the coder with the question is taken away from his/her work. Limiting the coder questions to a single source has an additional advantage, in that it provides the hospital with data about the most common questions. This data can be used to provide education for all coders.

It’s not difficult to see how the above concept is basically a coding help desk. If you’ve never operated a help/service desk before, see our guide “Data Driven Service Desk” for some guidance on how to operate a service desk, or contact us for assistance.

Consider that, once the coding help desk is created, it will be beneficial to enable questions from billers, schedulers, and others within the organization. Also consider offering access to the coding help desk to affiliated physicians offices as part of the organization’s physician engagement strategy.

If you haven’t already read the previous posts in this series, you can access them here >>

Related Posts