We have been living with ICD-10 for nearly 30 days now, and I think things are going fairly well. What I would like to discuss is coder productivity and accuracy in the hospital setting.  

I was a bit concerned when I was told that offshore coders are only coding 12 inpatient records per day. That is very low in comparison to the typical U.S. productivity standard of 24 per day. Why is it so low? 

 

I would assume that lack of preparation for ICD-10 had a big impact on the significant drop in productivity. But I would be anxious right now if I had outsourced my coding offshore. It appears that many internationally located coders are overworked, putting in much overtime (which our coders are as well). Also, many are new, inexperienced coders, and they are selecting more unspecified codes, not reading the documentation, and generating significant error rates. In some cases, in an attempt to meet productivity standards, the offshore coders are not capturing the entire clinical picture in the coding, which could have a significant impact to your bottom line. 

In many cases, it does not appear that dual coding took place among many of these offshore companies, which puts them at a huge disadvantage. It is important that if a hospital is using offshore coders, due diligence is performed in finding out if the coders were properly trained and how quality is measured. Productivity was expected to fall by 50 percent or more domestically, but with our contract coders in place, in many hospitals it is hard to measure productivity right now.  

But I have been reviewing individual coder productivity in the U.S., and I am not seeing more than a 5 to 35 percent drop in productivity so far depending on size of organization.

Some of the issues in productivity reduction could be due to issues such as different search terms in the encoder, the need to reference the ICD-10 code book, and anxiety about selecting the right code, especially with the injury codes. Inpatient coders have not had to use code books in years, so that has been challenging as well. Hospitals that have a coding hotline or an experienced ICD-10 coder or consultant available to assist will help keep productivity up.

Most hospitals are going to use contract coders until the end of the year, so we will actually have the opportunity to perform a more accurate measurement of productivity in 2015.  

It is important to first have policies in place to ensure compliance, but also to standardize and set expectations for each coder.  

The first item to consider is accuracy. Most of my clients have set the bar high, between 95-98 percent accuracy. The Office of Inspector General (OIG) standard is 95, but the goal to strive for, of course, is 100 percent. Ninety percent is considered acceptable or commendable, but anything that falls below 90-percent accuracy should be addressed immediately.

One of my clients has a policy that anything below 90 percent results in the coder being placed on probation. The standard for accuracy is reported in three areas:

  • Needs Improvement: 80-89 percent
  • Commendable: 90-97 percent
  • Exceptional: 98-100 percent

I think this is an excellent policy to quantify accuracy expectations.

It is also important to begin to think about analyzing productivity and modifying or changing your productivity goals. I have one client that bases their productivity on a point system and others whose benchmarks are based on how many charts are coded based on type – and quantified by minutes, hours, and date.

Here is the average standard that most small to medium-size hospitals have set: 

Average hospital productivity standard prior to Oct. 1, 2015. 

Type of Claim

Records Per Hour

Records Per Day

Average Time per record

Inpatient

3

24

20 minutes

Outpatient (ambulatory, interventional, surgery, and procedures)

5

40

12-15 minutes

Emergency department

15

120

4-5 minutes

Ancillary services including testing and lab and radiology

30

240

2-3 minutes

I have one client that has broken down services based on type of coding, such as IV therapy, surgeries by type, and GI versus interventional, for example. Keep in mind that the more complex the coding, the more time it will take. 

One suggestion to measure where your productivity is now is to look at your productivity by coder and/or type of coding from October 2014 through October 2015 to identify if any productivity loss exists, and if so, the percentage of loss. This should be a report that you run each month for the next 12 months, looking to make strides to get productivity back to what it was in 2014. 

Many hospitals will not use the data from March to Sept. 30 to analyze productivity if they were dual coding during this period because production would be reduced in such an environment.

Stay on top of productivity and accuracy, and if productivity significantly drops, find out why and quickly make corrections to avoid a disaster. 

When monitoring accuracy, it is a good idea to begin auditing inpatient coders now to correct errors and get them on the right track. You should continue to audit and monitor each quarter to ensure accuracy in the coding.

Productivity and accuracy is important to ensure proper payment and getting claims paid quickly.

 

Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP, Certified Clinical Documentation Improvement Practitioner

Deborah Grider has 34 years of industry experience and is a recognized national speaker, consultant, and American Medical Association (AMA) author who has been working with ICD-10 since 1990. She is the author of “Preparing for ICD-10, Making the Transition Manageable,” “Principles of ICD-10,” and the ICD-10 Workbook, among many other publications written for the AMA. She has assisted hospital systems and physician practices in transitioning and understanding ICD-10 for many years. She is a senior healthcare consultant with Karen Zupko & Associates and a clinical documentation improvement practitioner helping physicians improve clinical documentation among all specialties.

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