Avoid Surprises with Lower Coder Productivity, Develop a Measurement Tool






By Cindy Doyon, RHIA, and Cheryl Servais, MPH, RHIA


We often have heard the expression that “I need to run faster just to keep up!” This describes the situation with coding today. You and your coders may feel that productivity is slipping; that it’s taking longer to do the same work that you did last year. And that notion, in all likelihood, is accurate.

Productivity Study Results

Precyse recently conducted a study trending the productivity statistics of coders completing a large volume of inpatient records. The results are startling.



Chart Type

2009 12-mo Average Chart/Hour

2010 12-moAverage Chart/Hour

2009 - 2010 Change


% Change






Table 1


Table 1 illustrates that in 2009, coders completed a total of 64,107 records and averaged 2.38 inpatient charts per hour. In 2010, that average dropped to 2.10 inpatient charts per hour – a decrease of nearly 12 percent (11.76 percent). Put another way, in 2009 coders averaged 17.85 inpatient records per workday (7.5 hours), but in 2010 they averaged 15.75 – a decline of 2.1 records per day. That’s a decrease of 10.5 records per week, per coder; or 42 fewer records per month, per coder. To code the same number of records in 2010 as were coded in 2009, the average coder would need to work more than 20 additional hours each month!

Why is this productivity loss occurring? There are several reasons.

Present on Admission Impact

One of the reasons for the decrease in productivity is the additional time required to enter the codes for the “present on admission” status of each diagnosis code. This code is appended to the ICD-9-CM diagnosis code to indicate whether a condition represented in the record was present at the time of patient admission or whether it developed during the hospital stay. The present on admission codes are used by CMS to eliminate conditions that developed during hospitalization from being counted as a major complication/co-morbid condition (MCC) or a complication/co-morbid condition (CC), which could increase MS-DRG (Medicare Severity – Diagnosis Related Group) reimbursement.

CMS issued a list of codes that indicate hospital-acquired conditions that CMS feels could have been prevented if the hospital and the treating physicians had followed proper protocols.

Reporting Additional Diagnoses and Procedures

With the implementation of the 5010 claim form (effective Jan. 1, 2012), providers will have the option to submit more diagnosis and procedure codes. Claim forms will allow up to 24 diagnosis codes rather than nine, and up to 24 procedure codes instead of six. While some providers already are coding up to 24 diagnosis and procedure codes, many are not. For these providers, there is an opportunity to increase the information submitted to payers and others about the medical necessity for services provided.

In those facilities where coders have been limited in the number of codes they assign, this change may require those coders to spend more time reviewing the record and determining which codes to use. The coders also will need to determine the correct present on admission codes for all the additional diagnosis codes reported.