Updated on: February 13, 2019

AHIMA Coding Productivity Study and Preparing for ICD-11

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Original story posted on: February 11, 2019

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Planning is underway now for ICD-11.

The American Health Information Management Association (AHIMA) has been getting involved in the development of ICD-11 through its participation in the World Health Organization’s (WHO’s) activities, as well as providing members with high-level overviews of what to expect with the new classification system. 

ICD-11 has yet to be approved by the World Health Assembly. This is expected to occur in May of this year. ICD-11 is not scheduled to go into effect until 2022, meaning that this is the earliest it will be available to implement. It is too early to know when ICD-11 will be implemented in the United States.

When the time comes, AHIMA will be well-positioned to lead ICD-11 advocacy efforts, support ICD-11 adoption and implementation, and provide education to coding professionals and other stakeholders. 

Until then, AHIMA will continue our support for ICD-10-CM/PCS. A new coding productivity white paper was recently released. Coding productivity is an essential part of health information management operations focusing on high-quality, safe, and cost-effective healthcare.

Knowing that AHIMA needed to set the stage for a successful transition from ICD-9-CM to ICD-10-CM/PCS, coding productivity benchmarking study was conducted in 2007. This study showed an average of 20 minutes were needed to code an inpatient record, making for a rate of approximately three records per hour. 

With a relatively new classification system and laser-focused demands on the revenue cycle, AHIMA is working to create new coding productivity benchmarks going forward. To begin with, we are building on previous data captured.     

The first post-ICD-10-CM/PCS coding productivity study was conducted in early 2016. This study examined average inpatient coding times within more than 150,000 medical records from large healthcare facilities. The authors of the study were able to validate that inpatient coding productivity immediately decreased upon the changeover to ICD-10-CM/PCS, but it gradually increased over the weeks immediately following the Oct. 1, 2015 go-live date. Productivity began at 42 minutes per inpatient record (or 1.4 records an hour) in October, and by the end of February 2016, it had improved to 40 minutes or 1.5 records per hour. 

The second coding productivity study in the spring of 2016 found an ongoing increase in coding productivity over time as well. This second study evaluated more than 165,000 inpatient records and produced findings showing that inpatient coders required 38.1 minutes (on average) per record.

In addition, the second study found a positive correlation between an increased case mix index (CMI) and the amount of time needed to code an inpatient record. This is in direct correlation to today’s patients, who have increasingly complex health issues. While more data is needed to evaluate the impact on patient acuity levels, it is highly likely that they were responsible for some level of change in coding productivity in this study. 

It’s important to put these findings as well as the 2007 benchmarking study results into context since healthcare has significantly changed and will continue to change over time.    

The revenue cycle will continue to be a major focus for healthcare organizations as we move closer to quality and value-based care. Also, as more healthcare organizations implement computer-assisted coding technology, there will be some degree of coding productivity impact.    

AHIMA is taking this opportunity to review professional development, certification offerings, and coder compensation benchmarking models to meet the future needs of our members and the industry. In addition, a comprehensive follow-up coding productivity study is underway, with results expected later this year.

Julie A. Dooling, MSHI, RHIA, CHDA, FAHIMA and Melanie Endicott, MBA/HCM, RHIA, CDIP, CHDA, CPHI, CCS, CCS-P, FAHIMA

Julie A. Dooling, MSHI, RHIA, CHDA, FAHIMA, is a director of HIM Practice Excellent for AHIMA.

Melanie Endicott

Melanie Endicott is senior director of HIM Practice Excellence for AHIMA. In her role, she provides professional practice expertise to AHIMA members, the media and outside organizations on coding and clinical documentation improvement (CDI) practice issues.

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