ICD-10 Requires a Strategy for Managing the Coder Shortage

Limited coding resources long have been an industry reality. According to a June 2011 survey by the American Health Information Management Association (AHIMA), 40 percent of respondents said shortages were the result of a lack of qualified coders.(1) This mirrors similar findings from a 2009 AHIMA survey on coding practices. In a discipline rife with change, the coder shortage problem only will exacerbate problems as organizations migrate to ICD-10.

One reason the coding shortage is likely to persist is that the industry will need more coders to minimize productivity decline while staff training on ICD-10 gets underway. Even when this training is complete, organizations will continue to experience a decline in productivity due to implementation and go-live efforts (plus the inherent learning curve in using the new code sets).

With significant changes to diagnostic and procedural code sets in ICD-10, healthcare organizations need to identify a solution to address the continuing coder shortage. According to the U.S. Bureau of Labor Statistics, medical records and health information technicians held about 172,500 jobs in 2008, the year for which the most recent data is available.(2) As healthcare organizations continue to move to electronic health records and ICD-10, many seasoned coders have said they will retire rather than learn a complex new system.

While creating a retention plan for coders should be part of the solution, it is estimated that there will be as much as a 50 percent drop in coder productivity upon implementation of ICD-10 on Oct. 1, 2013. Similar to a pattern seen with MS-DRGs, the increased complexity of the coding model will keep productivity lower than it is today by at least an estimated 20 percent. Coder shortages, an accelerated demand for qualified coders and a decrease in productivity of existing coders all can increase business risk and impact profitability, requiring organizations to identify and implement a solution rapidly.

Making the Right Move

Healthcare providers have several options to manage the impending coder shortage. They can choose to focus on developing in-house capabilities, they can augment existing processes with technology or they can outsource coding to a trusted partner.

Keeping coding in-house requires a significant investment of time and resources with no guarantee of on-time delivery or success. Recruiting, hiring, managing, training and retaining coders during a period of change will require creativity and pose additional challenges to overcome.

Beyond the costs associated with recruiting and actual training, time spent bringing staff up to speed also will result in lost opportunities. Productivity will be stalled or decline every time there is staff attrition or while employees are learning proper coding in ICD-10. Adding additional staff to offset this as part of process engineering may be helpful in managing the transition, but it also creates additional challenges. Once new internal coders are trained, organizations may be faced with managing a potential workforce reduction, which can be costly and damaging to an organization’s reputation and morale.

Reengineering processes with technology is another consideration. However, when it comes to migrating to ICD-10, quality management is a key concern. For example, organizations will need to eliminate as many superfluous queries and unspecified codes as possible to gain the full benefit of the new code set. Misuse of unspecified codes could result in significant billing issues. With ICD-10’s expanded code set there is more to know and consider, so new technologies such as computer-assisted coding applications may be needed to boost productivity and increase coding accuracy.


(1) American Health Information Management Association (AHIMA) 2011 Coding Survey, http://journal.ahima.org/2011/07/01/for-coding-a-time-of-high-priorities/ (retrieved Sept. 21, 2011).

(2) Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2010-11 Edition, Medical Records and Health Information Technicians, on the Internet at http://www.bls.gov/oco/ocos103.htm (visited Sept. 21, 2011).