Survey: Coding Productivity Fell After ICD-10 Implementation

June 15, 2016
After the ICD-10 go-live on Oct. 1, many providers, in the weeks that followed, reported only minimal disruptions. Now, seven months after ICD-10 implementation, the results of a new survey of coding professionals indicates there was a decrease in productivity.

After the ICD-10 go-live on Oct. 1, many providers, in the weeks that followed, reported only minimal disruptions. Seven months after ICD-10 implementation and the results of a new survey of coding professionals indicates there was a decrease in productivity.

The American Health Information Management Association (AHIMA) Foundation conducted a survey in the first three weeks of May and coding professionals who responded noted they experienced a 14.15 percent decrease in productivity. The respondents also indicated they experienced a slight, 0.65 percent, decrease in accuracy as well.

Of those who responded, 67.9 percent noted a decrease in coding productivity, 5.8 percent experienced a productivity increase and 26.3 percent saw no change in productivity. In terms of accuracy, the majority of respondents (61.5 percent) reported no change in coding accuracy, with 26.9 percent reporting a decrease in coding accuracy and 11.5 percent experienced in an increase in accuracy.

“Health information management (HIM) professionals are already coding with the same degree of accuracy as in ICD-9,” Lynne Thomas Gordon, AHIMA CEO, said in a statement. “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.”

In the AHIMA Journal, AHIMA Foundation leaders said the decrease in coding productivity was in line with their expectations.

“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,” Kate Jackson, the Foundation’s research manager, said in a statement.

The level of the decrease in both productivity and accuracy varied depending on the type of setting in which the individual is employed (in-patient or outpatient facility), as well as factors like years of experience, level of education, and the use of encoder or computer assisted coding products (CAC).

Among individuals working in an in-patient setting who perceived a decrease in their coding productivity, the average decrease was 24.30 percent while those in an outpatient setting perceived a decrease of 22.10 percent. Similarly with regard to accuracy, those working in an in-patient setting reported an average decrease in accuracy of 13.25 percent and those in outpatient settings indicated an average decrease of 10.58 percent.

According to the survey results, the level of coding experience impacted productivity—those with one to five years of experience encountered the lowest levels of decreased productivity, while those with between six and 10 years of experience had the highest levels of decrease (19.97 percent and 27.14 percent, respectively).

Also, 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).

According to the AHIMA Journal article, the survey investigators noted 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.

“Results from our analysis on use of a CAC for coding seem 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,” the survey report authors stated.

The survey report authors suggested that further researched was needed to investigate whether or not levels of productivity will revert to pre-ICD-10 levels; whether productivity and accuracy levels will increase as the use of CACs become more ingrained into the coder workflow and also to provide more clarity in defining accuracy.

With the implementation of ICD-10, the number of diagnosis codes for healthcare services has increased from 13,000 to 68,000, and the number of procedure codes has also increased. The new codes allow for greater specificity of reporting diagnoses and care delivered.

The AHIMA Foundation survey report cites a report from the RAND Corporation also notes that the new code set has resulted in a number of costs including training, loss in productivity, and system changes and updates. “In spite of these, RAND indicates that the change to ICD-10 may assist in improving disease management, reducing miscoding or inappropriate coding, and better understanding healthcare outcomes.”

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