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EDITOR’S NOTE: This is the second in a series of articles addressing the definitions and differences between the medical and surgical root operations.


Our focus today is the four root operations that put in/put back or move some or all of a body part. As per the ICD-10-PCS book, we will review the definitions, explanations and some examples of each. We also will introduce the coding guidelines applicable to these procedures.

Transplantation (Y)

Definition:  Putting in or on all or a portion of a living body part taken from another individual or animal to take the place and/or function of all or a portion of a similar body part.

Explanation:       The native body part may or may not be taken out, and the transplanted body part may take over all or a portion of the original part’s function.

Examples: Kidney transplant, heart transplant

Coding Guideline: Transplantation vs. Administration (B3.16)

Putting in a mature and functioning living body part taken from another individual or animal is coded to the root operation of transplantation. Putting in autologous or nonautologous cells is coded to the administration section. For example, putting in autologous or nonautologous bone barrow, pancreatic islet cells or stem cells is coded to administration.

Reattachment (M)

Definition:  Putting back in or on all or a portion of a separated body part, affixing it to its normal location or another suitable location.

Explanation: Vascular circulation and nervous pathways may or may not be reestablished.

Examples:  Reattachment of hand, replantation of avulsed scalp, closed replantation of three avulsed teeth.

Transfer (X)

Definition:  Moving, without taking out, all or a portion of a body part to another location to take over the function of all or a portion of a body part.

Explanation: The body part transferred remains connected to its vascular tissue and nervous supply.

Examples: Tendon transfer, skin pedicle flap transfer, trigeminal-to-fascial nerve transfer, percutaneous endoscopic

Reposition (S)

Definition:  Moving all or a portion of a body part to its normal location or another suitable location.

Explanation: The body part is moved to a new location from an abnormal location, or away from a normal location where it is not functioning correctly. The body part may or may not be cut out or off to be moved to the new location.

Examples:  Reposition of undescended testicle, fracture reduction

Coding Guideline:  Reposition for fracture treatment (B3.15)

Reduction of a displaced fracture is coded to the root operation of reposition, and the application of a cast or splint in conjunction with the reposition procedure is not coded separately.  Treatment of a nondisplaced fracture is coded to the procedure performed.

For example, putting a pin in a nondisplaced fracture is coded to the root operation of insertion. Casting of a nondisplaced fracture is coded to the root operation of immobilization in the placement section.



As you can see from review of this group of medical and surgical root operations, not all of the language should be foreign to a physician. In the above group of procedures, the only term that will require coder translation is “reposition.” The documentation in the record will continue to indicate an open reduction, internal fixation or ORIF, and the coder will need to translate to “reposition” as the root operation.

Our next group of procedures to explore is those that take out or eliminate solid matter, fluids or gases from a body part, actions that include the root operations of drainage, extirpation and fragmentation. We also will focus on the group of procedures that involve only examination of body parts and regions: inspection and map.

About the Author

Becky DeGrosky, RHIT, is the Product Manager for TruCode. She brings over 35 years experience in health information management.  She worked for 11 years in HIM software development for QuadraMed and MedAssets, including product management, content maintenance, implementation and training, and client support.  She is an active member of the Pennsylvania Health Information Management Association, where she has served on multiple committees including Chairman of the Education Committee and the Coding Roundtable.

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When conversations about the preparations for ICD-10-CM arise, some providers have the same response: “Hold on a minute! How can we prepare for ICD-10 when we don’t know where we stand with ICD-9”?

It’s an obvious question, but one that’s not getting asked too frequently. Still, shouldn’t practices take a fiscal snapshot of internal operations while engaged in ICD-9-CM, which establishes the basis for medical necessity of all services, before diving into ICD-10-CM? It just might be one of the most overlooked common-sense starting points.  In this way, fiscal comparisons can be made following the transition to ICD-10-CM starting on Oct. 1, 2013.

In this day and age, it seems as if financial management of medical practices should be getting simpler. With the preponderance of electronic tools, various software programs and even the Internet, one can practically “Google” quick, effective assistance and problem-solving. But perhaps a return to the basics is in order, especially in preparation for looming changes such as ICD-10-CM.


Taking a fresh look at the basics of billing and collections is a good way to re-acquaint yourself with financial formulas that indicate how your practice is performing under ICD-9-CM. Fundamental components of analyzing accounts receivable (A/R, or the amounts due to your practice for services rendered) include being familiar with the following three financial elements of each patient care episode:

  • Charges: full fee amounts for services provided;
  • Adjustments: amounts deducted per contractual obligations, usually with HMOs, PPOs and other payers; and
  • Payments: amounts paid to the practice by patients and payers (receipts).

Collections Ratios:

The collections ratio is a percentage that reveals how much your practice is collecting during a defined time period compared to how much it should be collecting. This ratio is based directly on the practice’s charges.

There are two basic types of collections ratios: gross and net. The gross collections ratio, defined as receipts divided by gross (unadjusted) charges, differs slightly from the net collections ratio, defined as receipts divided by adjusted charges. Those adjustments range from payer participation adjustments a practice is contractually bound to make to various legitimate patient discounts such as charity case adjustments, etc.

Obviously, the more useful of the two aforementioned ratios is the net collections ratio.  Taking into account adjustments mandated by HMOs, PPOs and other insurance plans (plus various patient discounts), this ratio reveals precisely how a practice’s adjusted charges translate into fees. It also provides a more accurate reference point for financial comparisons than the gross collections ratio provides by clearly demonstrating what the practice should be collecting.

Importantly, in this era of economic downturn and managed care pressures (when most actual charges must be adjusted down to net charges), the expected norm for the net collections ratio should be very close to 100 percent. Less than 100 percent net collections might point to problems including payer issues such as (a) slow payers and/or (b) denied or pended claims by payers; as well as internal practice operational issues such as (a) slow claims generation timelines being maintained by a practice’s billing staff, (b) unresolved patient portion or patient due amounts, (c) failure to make mandatory adjustments to patient accounts and/or (d) poor overall A/R management.

Within A/R management, the process used to generate reports in a practice’s billing system (see below for more details) should be flexible enough to allow for the use of various parameters such as net collections year-to-date (YTD) among all patient types, net collections filtered by specific traditional payers (such as Blue Cross/Blue Shield), net collections for HMOs, net collections for self-pay patients, etc. And commonly, the A/R report, once adjusted amounts are taken out, will demonstrate the current collectible A/R as well as amounts “out” 30 days, 60 days, 90 days, 120 days and more than 150 days. From this perspective, these “buckets” can be studied for inherent problems as previously mentioned, using payer issues and internal practice operational issues as criteria.



Adjustment Ratio:

The adjustment ratio is a simple calculation indicating the degree to which a practice’s gross charges are being adjusted. Ultimately, this reveals how close to realized practice income original gross charges are, plus where a practice’s fee structure is in relation to actual receipts.

Factors influencing this ratio include (a) the number of practice-affiliated HMOs/PPOs and other payers that mandate contractual adjustments and (b) how high or low the current gross fee structure is in relation to the majority of payer fee schedules. This calculation can be performed in a number of ways, the simplest being simply dividing a specific time frame adjustment (i.e. current month or YTD) by the gross unadjusted charges for the same time frame:


$40,000 Adjustments September 2011 YTD

$100,000 Gross Charges September 2011 YTD

= 4.0 or 40 percent Adjustments

Remember, again, this figure can be studied in a number of ways to provide different perspectives on the same information. For instance, if the practice has a high adjustment ratio but also has a large patient population of self-payers and/or private insurers (generally paying fee-for-service from gross charges), a practice fee structure revision need not take place. However, if the practice has a high adjustment ratio and 75 percent HMO/PPO patients comprising the patient population, a fee schedule analysis might be in order. In the latter case, the gross charges may never be realized fully, resulting in inflated gross charges and adjustments with a mountain of adjustment transactions to be done – and that seriously can overburden an already busy billing staff.

A/R in Time Ratios:

This quick set of calculations reveals how much time, on average, patient accounts are held in A/R status (versus being paid and resolved) once all mandatory adjustments are made. The months-in-A/R and days-in-A/R ratios are useful tools that provide snapshots of overall A/R standings.

For months-in-A/R, first determine from your billing system-generated reports the A/R for the month under study, i.e. September 2011. Then, for the period “YTD September 2011,” add up each month’s A/R figure and divide the sum by nine to yield an average of the A/R through September. Put these figures into the calculation for the A/R ratio:

September 2011 A/R amount

Averaged A/R through September 2011 = Months-in-A/R


$98,000 A/R for September 2011

$77,500 averaged A/R through September 2011

= 1.26 Months-in-A/R

The above example reveals that the practice’s months-in-A/R ratio is 1.26 months.  Note that this can be done using gross (unadjusted) A/R as well, but if the practice makes contractual adjustments during posting of charges (instead of during posting of payments) based on fee schedules preloaded in the billing system, the net months-in-A/R calculation becomes an even more accurate tool. However, even with unadjusted amounts, this ratio still provides a good reference point – using time – for figuring out how mature the A/R is on average.

Days-in-A/R follows suit, taking the months-in-A/R final calculation and then multiplying that figure by 30.4 (the average number of days in any given month). In the above example, 1.26 months-in-A/R is multiplied by 30.4 for a total of 38.3 days-in-A/R. This figure is reflective of the average number of days any single claim remains in the A/R, or from another perspective of the time it takes any particular claim to liquidate fully and be paid. Therefore, this particular practice has an average of 1.26 months’ worth or 38.3 days’ worth of A/R awaiting final payment or account resolution.




Detailed reports should be generated on a timely basis each month as well as at the end of each year via the practice billing system. The responsibility for these reports should rest with the billing or office manager. The reports module of the billing system should allow for flexibility in report generation so that both high-level reports as well as detailed listings (down to patient account levels), can be demanded. The reports should be produced in a variety of ways, but physicians often find targeted reports to be most helpful. These can include, for example: (a) A/R aging reports, including current, 30 days, 60 days, 90 days and more than 120 days, with billing staff notes detailing account work; (b) A/R by insurance type (i.e., by payer, including self-pay patients); (c) A/R by suspended, pended or unbilled accounts (this report ensures that no accounts remain hidden during the reporting process); and (d) accounts written off to collections (typically those of more than 120 or 150 days unless the practice is at fault for the untimely filing of claims, etc.).

A few other basic but useful reports are (a) A/R by referring physicians/providers to help spot lucrative as well as perhaps unhealthy referral sources (i.e. referral sources for which high numbers of patient accounts remain uncollected); (b) A/R by service type (i.e. CPT or HCPCS-II codes) to analyze types of services being rendered as well as A/R attached to those services; and (c) A/R month-to-date and year-to-date as compared with last year’s figures, for year-by-year comparisons of practice growth or other changes.

In terms of changes, the transition from ICD-9-CM to ICD-10-CM can be gauged as well.  These reports, when adding filter criteria for, say, the current top 25 ICD-9-CM codes reported on claims, also can provide a focused picture of monies pending or generated related to specific diagnoses. That criterion, that is, the diagnosis code, considered together with other influencing data such as payer type, can demonstrate differences in payments for the same services with the same diagnosis code coming from different payers. Using ICD-9-CM codes among the filtering criteria for fiscal reports can be applied in innumerable ways and can be an eye-opening exercise.

These fundamental but evergreen physician practice formulas provide quick and useful data when monitoring the health of the practice’s A/R. They also can provide a snapshot of the practice as it stands under ICD-9-CM before the big transition to ICD-10-CM.

About the Author

Michael G. Calahan, PA, MBA, is the director of physician services at KForce Healthcare, Inc. Michael has more than 25 years of experience in health care, beginning as a physician assistant with the USN. He has served as an administrator for several physician practices and has enjoyed a varied career in healthcare consulting, being affiliated with Ingenix, CGI, Navigant, PWC and Parente-Randolph. He has authored numerous industry publications and articles in physician, IP/OP/ASC, DMEPOS, ESRD, HHA, ambulance, HIPAA and in Medicare Parts C & D for Medicare Advantage.

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The transition from ICD-9-CM to ICD-10-CM/PCS is beginning to take shape as many providers scramble to prepare for the Oct. 1, 2013 compliance date. While some are just beginning their transition, others are thinking ahead to how they will manage the various challenges that ICD-10 will bring in 2013 and beyond. Of particular concern is an anticipated loss of coder productivity.

It is a fact that productivity decreases (at least in the short term) when workers are in training or learning a new skill. As we begin to learn more about ICD-10-CM/PCS, it is becoming clear that what we should be asking ourselves is not whether we think there will be a loss of coder productivity, but more specifically how much of a loss will there be, and for how long will it last? In our opinion a loss of productivity is inevitable, especially for inpatient coders, as they must learn two new code sets: ICD-10-CM for diagnosis coding and ICD-10-PCS for procedure reporting.

The anticipated loss of coder productivity stems from the changes that ICD-10-CM/PCS will bring, such as:

  • An increase in the volume of codes available for assignment, as this figure will rise from approximately 17,500 ICD-9-CM codes to 141,449 ICD-10-CM/PCS codes for 2011;
  • An increase in the number of characters comprising a valid code;
  • An increase in the specificity of approximately 20 percent of diagnosis codes and 99 percent of procedure codes;
  • An increase in the number of physician queries;
  • An addition of alphabetical characters to what was once only a system of numerical codes;
  • A complete overhaul of the procedure reporting system; and
  • Changes to coding guidelines.

The increase in the volume of codes available for assignment coupled with the enhanced clinical nature and specificity of these codes will require a more intense review of documentation, leading to more dialogue between coders and providers. As a result, it could take twice as long to code and finalize billing of an inpatient record using ICD-10-CM/PCS as compared to ICD-9-CM. But as with all new things, there will be a learning curve with ICD-10, and this one is predicted to last approximately six months (this is based on Canada’s and Australia’s experiences in transitioning to ICD-10). This is not to say that on April 1, 2014 our productivity losses attributed to ICD-10 magically will be reversed, as many expect a long-term loss of inpatient coding productivity ranging anywhere from of 10 to 30 percent.

Unfortunately, lost coder productivity will not be the only impact on cash flow resulting from ICD-10. Payers are expected to take longer to pay claims, and the payment error rate is expected to rise to as high as 10 percent as a result of an increase in coding, billing and payment errors. Given ICD-10’s predicted impact on operating costs and cash flow, it becomes apparent that we must give consideration to mitigating (to whatever degree possible) a loss of productivity that could jeopardize operations.

Luckily, solutions are available, but they will require greater efficiency in preparation, implementation and management of ICD-10. We suggest employing the following strategies:

Preparation for ICD-10 (now through mid-2013):

Implement a concurrent clinical documentation improvement program immediately.

  • A concurrent clinical documentation improvement program will ensure that documentation in the record at the time of discharge is clear, consistent and specific enough for coding purposes.
  • If you already have a concurrent clinical documentation improvement program, ensure that you are getting the most from it by contracting for an assessment and/or follow-up visits.
  • Provide coders with a proper introduction to ICD-10-CM/PCS, utilizing awareness training.
  • Evaluate your coders’ baseline skills and provide additional developmental training in medical terminology, anatomy and physiology, pharmacology, and pathophysiology.



  • Ensure that coders have an adequate degree of role-specific training, which consists of basic, intermediate and advanced ICD-10-CM coding training. The American Health Information Management Association (AHIMA) recommends 40 hours of role-specific training for coders. We suggest additional training, particularly in ICD-10-PCS for procedure coding.
  • Devote resources toward providing awareness and developmental and role-specific training; this will improve productivity and accuracy and ultimately preserve or enhance cash flow and revenue.
  • From an operational standpoint, mitigate coder productivity loss by:
  • Eliminating interruptions;
  • Eliminating abstracting of rarely used information;
  • Hiring training an abstractor for registry data collection;
  • Adding incentives for performance or introducing a career ladder program;
  • Implementing a remote coding program;
  • Ensuring adequate in-service and coding training based on annual audit results and changes to code sets, guidelines and payment methodologies;
  • Ensuring that the content and format of the record promote timely access to, and ease of, viewing scanned images and forms. Improve the design, color, text size and organization if necessary;
  • Ensuring adequate interfaces between groupers, encoders and abstracting systems;
  • Resolving connectivity issues; and
  • Considering automated tools such as computer-assisted coding (CAC) software applications or encoder software.

Implementation of ICD-10 (mid-2013 through Oct. 1, 2013):

First, don’t rely too heavily on contract coding services.The price of these services is expected to rise, and you still will need to monitor their productivity and accuracy, adding to the cost. Also:

  • Consider hiring new graduates for outpatient coding positions in 2012 and transitioning current outpatient coders to inpatient coder positions. There has never been a better time to transition from an outpatient coding career to inpatient. Ramping up your coding team will provide a permanent solution to productivity concerns and will cost less than long-term (or permanent) dependence on a contract coding.
  • Have coders specialize in specific types of inpatient procedure coding.

For example, assign one coder all thoracic procedures, and another all abdominal procedures. This decreases the learning curve and can improve accuracy as well.

Management of ICD-10 (Oct. 1, 2013 and beyond):

Manage ICD-10 by prioritizing clarification opportunities.

  • Query any time there is a more specific code available in ICD-10-CM is not beneficial, or even necessarily compliant. Some detail in ICD-10-CM is informational only and will not improve your data reporting significantly.
  • If clinical indicators, risk factors and impact on care are not documented, querying to assign a more specific code will not meet query guidance provided in AHIMA’s "Managing an Effective Query Process" (Journal of AHIMA 79, No.10, October 2008): 83-88..



  • Weigh the cost of obtaining a higher level of specificity against the outcome.
  • Avoid inundating physicians with clarifications/queries that are not truly adding value to your data or your bottom line.

Re-evaluate the diagnoses and procedures your inpatient coders currently are assigning.

  • If codes are assigned for internal purposes only, determine the benefit verses the cost of doing so with ICD-10.

While a loss of coder productivity with the transition to ICD-10-CM/PCS is inevitable, the sooner you begin to accept and prepare for this new reality, the better off you will be come 2013 and beyond. Take advantage of the time remaining to prepare coders for the transition to ICD-10 adequately by providing them with the necessary awareness and developmental and role-specific training necessary to improve productivity and accuracy with ICD-10.

About the Author

Angela Carmichael, MBA, RHIA, CCS, CCS-P, joined J.A. Thomas & Associates in 2008. She is a HIM Product Development Specialist specializing in clinical documentation improvement, coding education & reimbursement methodologies. Angela earned a Bachelor of Science degree, in Health Services Administration from Barry University and a MBA from Nova Southeastern University. She is a Registered Health Information Administrator and also has achieved the designations of Certified Coding Specialist, and Certified Coding Specialist-Physician and AHIMA Approved ICD-10-CM/PCS Instructor.

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“The perfect storm:” we hear this catch phrase all the time when referring to healthcare reform initiatives including MU, 5010/I-10, EMR, HIE, ACO, etc. It’s a good analogy considering the magnitude of the storms the Andrea Gail sword fishing boat faced in the real “perfect storm” and the magnitude of the multiple initiatives healthcare organizations are facing.

To refresh your memory of the 1997 book and 2000 movie, after debating whether to sail through the mounting storm or to wait it out, the crew decides to risk it. However, between the Andrea Gail and their homeport, a confluence of powerful weather fronts, which the Andrea Gail crew underestimated, resulted in the capsizing and sinking of the ship with the tragic loss of the entire crew.

The healthcare “perfect storm” pales in comparison to the loss of the Andrea Gail and crew, and while it might seem like it at times, no loss of life is anticipated with these initiatives. We can, however, identify a parallel analogy in deciding either to push through the storm or to try to wait it out and see what happens.

The First Storm

As we set our course for home with 5010, I struggle to understand why so many organizations have underestimated this effort and now find themselves in an undesirable path. Some organizations’ health plans have not mitigated 5010 risk for their data warehouses. Some health systems are relying on their clearinghouses to submit 5010-compliant claims, but have underestimated the 5010 impact on their secondary IT systems. Perhaps most surprising, though, is that some organizations have not started their 5010 conversion and cannot understand why they might not make the deadline.

Once you lay out all that needs to be accomplished in the next four months, the reality becomes quite apparent to any such organization that their chances of making the deadline are limited.

The one common thread with all three of these scenarios is the same: the attitude that “we had other major projects that consumed our resources and we couldn’t handle any more.” Did these organizations underestimate the magnitude of the effort? Did they chart their course paying too much mind to competing enterprise priorities to determine the best path? Did they underestimate the force of the storm?

Would Have, Should Have

I asked each organization if they would have done anything differently, and they all provided similar answers:

  • They would have started earlier to understand the efforts needed. Even though they had a two-year timeline, 5010 was new, and educating themselves on 5010 accounted for a delay in their mitigation activities.
  • They thought they were in better shape with 5010 than they were until they realized they needed assistance. They would have evaluated their progress along the way to re-prioritize earlier.
  • They would have coordinated major initiatives through a central PMO for one point of control and coordination of efforts. They had too many initiatives working in a silo full of staff consumed with their one specific initiative, resulting in inefficiencies and duplication of efforts.

I cannot say where these organizations will be in the next four months, or if they will be safe by January 2012. Would they make different decisions based on their experiences? One organization has, as it now has realized that two years is not a lot of time to prepare for a major initiative like ICD-10 readiness.

All will attempt to go through the same storm, as waiting it out is not an option.

About the Author

John Pitsikoulis, RHIA, is a Strategic Advisory Services Client Executive and ICD-10 Practice leader at CTG Health Solutions (CTGHS). John is responsible for the strategic advisory services such as ICD-10, EMR clinical documentation integration program, and Computer Assisted Documentation Services. John has over 25 years of Health Information Management (HIM), coding, and compliance consulting experience working with clients on ICD-10 services, RAC, coding, and clinical documentation improvement engagements.

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With every ICD-10 workshop, seminar, webinar, podcast and boot camp we attend, we learn different takes on how to implement ICD-10 successfully. Common to all these forms of guidance is the premise that one of the primary keys to success is provider commitment.

So how do we talk to our physicians about ICD-10? As a former CEO of a large multi-specialty group practice, I recall that my biggest challenge often was finding ways to engage providers in sometimes-distasteful pursuits. Gaining ICD-10 provider commitment is a challenge. Here are some do’s and don’t’s.

How not to talk to your doctors:

  • Don’t push ICD-10 as doom and gloom; try not to be a fear merchant. Providers don’t respond to “the end is near” approach. Be positive. Talk about the opportunity the transition presents for providers who are involved, supportive and ready to go. For every practice that takes a proactive stance, there will be hundreds of others that will be unprepared. Who do you think the insurance companies will be more likely to reimburse?
  • Don’t come off as overwhelmed when you speak to your physicians about ICD-10. Be confident – communicate your plan and let them know that you have their back but need their help. Make clear to your providers that they are an integral part of the process and that you will need their commitment, especially during ICD-10 budget time.
  • Don’t put the conversation off and don’t ignore the challenge. It won’t go away. Chances are, your providers are as concerned as you are but have not found the right way to start talking about the transition process. Taking the lead on their behalf could be a huge relief for them.

How to talk to your doctors:

  • Give concrete examples of what needs to be done to ensure a smooth transition. An excellent easy way to start the provider conversation is to perform a documentation chart audit; what this does is gauge your current documentation’s ability to support ICD-10 codes. Pull the charts, use an automated GEMs tool to translate your codes from ICD-9 to ICD-10 quickly, and check the current documentation’s ability to support specific ICD-10 code choices. For example, asthma coded in ICD-10 requires a description of the degree of severity. “Mild intermittent,” “mild persistent,” “moderate persistent” and “severe persistent” are the ICD-10 descriptions for asthma. An essential part of this exercise is the report card. Providers are competitive. So for the asthma example above, give them feedback on your audit results, but most importantly, give recommendations that help them understand the new requirements.
  • Providers will appreciate any tools or tips you can provide that help them understand what they need to do to transition successfully. Here is another useful way to start the conversation: using an automated GEMs tool, convert your 30 most frequently used diagnosis codes and create flash cards or other quick-reference documentation tools. The example below shows the ICD-10 documentation required to code fracture of the patella.



Fracture of the Patella – Documentation Tips

  • Open or Closed
  • Displaced or Non-displaced
    • Osteochondral
    • Longitudinal
    • Transverse
    • Comminuted
    • Other
  • Type of Encounter: Initial, Subsequent or Sequela
  • Degree of Healing
    • Routine
    • Delayed
    • Malunion
    • Non-union






















  • Providing tools kick-starts the ICD-10 talk. Your providers will appreciate the help and likely will become engaged in the overall ICD-10 transition process.
  • When you speak to your doctors, be informed. Physicians appreciate a cogent, coherent conversation that reflects confidence in the content. Respect their busy schedules by staying on point and demonstrate your commitment to the process by letting them know that you have done your ICD-10 homework.

An ICD-10 conversation with your providers doesn’t have to be uncomfortable, and it won’t be if you follow these simple rules. Be brave. Don’t put it off. Remember, being prepared for ICD-10 puts your practice in the minority. Your providers will appreciate a timely and frank exchange about ICD-10. Chances are, they are as apprehensive as you are about starting “the talk.”

About the Author

Dennis Flint is director of consulting and educational services for Complete Medical Solutions. Dennis formerly served as the CEO of a large, multi-specialty physician group, a full service MSO and was a certified professional coder through AAPC. He has authored or co-authored numerous “common sense” practice management books and implementation manuals. Educated at the United States Air Force Academy, he had a distinguished career as an Air Force pilot flying numerous secret and sensitive missions.

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In the ICD-10 procedural coding system (PCS), identifying the root operation— the third character in the PCS code—is integral to assigning codes. This character defines the “objective” of the procedure, and 31 root operations are included in the medical and surgical section of the PCS.

While some of the terms are similar to ICD-9-PCS, the definitions differ except in a few cases (such as the following terms: resection, excision and removal). It is important for coders to understand the differences between the root operations, which can be divided into nine categories.  Each category has several terms with specific definitions.

Per CMS guidelines, it is the coder’s responsibility to determine what the documentation in the medical record equals in the PCS definitions.  The physician is not expected to use the terms that are in the PCS code descriptions.  As such, learning the definitions of these terms and being able to apply them to the physician documentation is an important part of a coder’s ICD-10 PCS education.

The rest of this article separates the root operations by category and then lists the Centers for Medicare & Medicaid Services’ definitions of each operation.

Root Operation: Removing Some or All of a Body Part

  • Excision—cutting out or off, without replacement, a portion of the body part
  • Resection—cutting out or off, without replacement, all of a body part
  • Detachment—cutting off all or part of the upper or lower extremities
  • Destruction—the physical eradication of all or a portion of a body part by the direct use of energy, force, or a destructive agent
  • Extraction—the pulling or stripping out or off all or a portion of a body part by the use of force.

Root Operation: Removing Solids, Fluids, or Gases

  • Drainage—taking or letting out fluids and/or gases from a body part
  • Extirpation—taking or cutting out solid matter from a body part (i.e., foreign body)
  • Fragmentation—breaking solid matter in a body part into pieces.

Root Operation: Cutting or Separating a Body Part

  • Division—cutting into a body part without draining fluids and/or gases in order to separate or transect a body part
  • Release—freeing a body part from an abnormal physical constraint by cutting or using force

Root Operation: Putting In, Putting Back or Moving Some or All of a Body Part

  • Transplantation—putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and/or function of all or a portion of a similar body part
  • Reattachment—putting back in or on all or a portion of a separated body part to its normal location or other suitable location
  • Transfer—moving, without taking out, all or a portion of a body part to another location to take over its function
  • Reposition—moving all or a portion of a body part to its normal location or other suitable location



Route Operation: Altering the Diameter or Route of a Tubular Body Part

  • Restriction—partially closing an orifice or the lumen
  • Occlusion—completely closing an orifice or the lumen
  • Dilation—expanding an orifice or the lumen
  • Bypass—altering the route of passage of the contents

Route Operation: Use of a Device

  • Insertion—putting in a non-biological appliance that monitors, assists, performs, or prevents a physiological function but does not physically take the place of a body part
  • Replacement—putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part
  • Supplement—putting in or on biologic or synthetic material that physically reinforces and/or augments the function of a portion of a body part
  • Change—taking out or off a device from a body part and putting back an identical or similar device in or on the same body part without cutting or puncturing the skin or a mucous membrane
  • Removal—taking out or off a device from a body part
  • Revision—correcting, to the extent possible, a malfunctioning or displaced device

Route Operation: Examination Only

  • Inspection—visually and/or manually exploring a body part
  • Map—locating the route of passage of electrical impulses and/or locating functional areas in a body part

Route Operation: Other Repairs

  • Control—Stopping, or attempting to stop, post-procedural bleeding
  • Repair—restoring, to the extent possible, a body part to its normal anatomic structure and function

Route Operation: Other Objectives

  • Fusion—joining together portions of an articular body part and rendering it immobile
  • Alteration—modifying the natural anatomic structure of a body part without affecting its function
  • Creation—making a new genital structure that does not physically take the place of a body part

Peggy Hapner is manager of the HIM consulting division at Medical Learning Inc. (MedLearn), St. Paul, MN.

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The ICD-10 countdown continues, as all certified coders are facing the task of familiarizing themselves with the new coding system.

With Oct. 1, 2013 on the horizon, many will be preparing to take ICD-10 certification exams as part of certain coding association requirements. Paper and electronic methods are the two paths coders face as they begin to think about an attack on ICD-10 – so which path should you choose?

The use of the word “attack” is widespread, as every U.S. organization is faced with transitioning from roughly 60,000 codes in ICD-9 to more than 150,000 in ICD-10. The numbers are overwhelming; so overwhelming, in fact, that many seasoned coders have stated that they will retire before ICD-10 is implemented. Being that many coders are visual thinkers, many believe that paper is the only option, specifically since those sitting down to take the ICD-10 certification exam will need to use a paper ICD-10 code book.

Whether you are a coder, a HIM director with coding staff or part of an ICD-10 risk assessment committee, do you know how you, your team and/or your organization are going to attack learning the ICD-10-CM and PCS coding systems? Many may default to paper code books, but if you think about coding from a workflow perspective, it makes the most sense to take advantage of modern technology. Still, there is no need to choose one or the other. You can pair them together as a single plan of attack and look for electronic tools that can assist coders in learning how to use the required paper code book.

Considering Workflow Tools

From a broader perspective, aside from the paper code book option, other types of ICD-10 workflow tools to consider obtaining include any that will assist in learning the actual code sets, assist in current workflow activity to translate codes from I-9 to I-10 and assist in learning ICD-10 from a regulatory standpoint. These tools possibly could include a subscription to electronic educational courseware, specifically sources with a strong focus in anatomy and physiology.

There are options out there in the marketplace, and many organizations already have multiple tools that may help them accomplish some of these objectives. Also, take a moment to assess the coding workflow. You soon will realize how your organization easily can limit coder apprehension about learning the new coding system, increase coder longevity and productivity and save money at the end of the day if you choose coding workflow tools wisely.

Workflow coding tools should provide the following in one easy-to-use format:

Coding – Ensure that electronic code books are available and contain both ICD-10-CM and PCS. The CM electronic code book should be comprehensive, featuring guidelines and indexes, and the PCS e-code book should include guidelines, indexes and a reference manual. The electronic code books should be paired with some type of ICD-9-to-ICD-10 translation tool. This tool should assist the coder in analyzing current code sets under ICD-9 in comparison to those in ICD-10.

Regulatory Resources – Correct coding is driven by regulatory information. Providing access to CMS notifications and regulatory issuances such as The Federal Register and CFR will be key to a coder’s success. Additionally, a quality coding workflow tool should have the capability to highlight and anticipate the addition of local and national coverage determinations as well as updates to the ICD-10 coding system in the form of CMS manuals and transmittals. Be prepared, as payers and CMS soon will provide direction for accurate claims submission as we continue to move forward towards ICD-10.

Education - Electronic educational courses paired with coding and regulatory information can be very powerful in helping the coder tie it all together. Courses should include not only a comprehensive overview of the ICD-10 coding system but also components related to anatomy and physiology, clinical implications, and medical terminology: items to help coders adjust to the specificity required by coding with ICD-10.



The Role of Technology

Evaluating technology used to facilitate learning of ICD-10 code sets is not an easy task, yet the technology should be able to do the following from a coding workflow perspective:

I. Offer an electronic translation tool that allows the user to perform a simultaneous keyword search of ICD-9 and ICD-10 for direct comparison (and not just by code searching).

II. Provide transparent access to the General Equivalent Mappings (GEMs) and reimbursement maps so that the search results are obvious and direct, including forward and backward mapping.*

*Many have argued that coders should not use GEMs to code or even have access to the reimbursement maps. The GEMs and reimbursement maps should serve solely as a guide for coders, and should not be seen as a replacement to actually learning the new coding system.

III. Provide understanding of the implications of ICD-10 on MS-DRGs via an interactive MS-DRG grouper.

IV. Present current and archived guidance to assist coders in understanding how ICD-10 impacts other coding areas such as claims processing, Medicare benefit policy rules and national and local coverage determinations.

V. Include free training and support; this is an unfunded mandate from the government. Although development is an incurred cost by vendors for these workflow tools, institutions should not be burdened with software installation and training costs.

Choose to be a leader in learning ICD-10, and pair paper code books with electronic tools to facilitate the transition. The use of electronic coding workflow tools not only will improve efficiencies and lower administrative costs, but also reduce coding errors and claim rejections. It will lead to achieving an organizational enterprise goal to be in compliance and submit clean claims correctly the first time.

About the Author

Maria T. Bounos, RN, MPM, CPC-H, is the Business Development Manager for Regulatory and Reimbursement software solutions for Wolters Kluwer.  Maria began her career at Wolters Kluwer as a product manager, responsible for product development, maintenance, enhancements and business development and now solely focuses on business development.  She has more than twenty years of experience in healthcare including nursing, coding, healthcare consulting, and software solutions.

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As we recently embarked on a campaign to update our ICD-10 workshop content, we thought it prudent to conduct a survey that took the pulse of current ICD-10 understanding. In concert with The Frank Cohen Group, we came up with questions that were meant to gauge the current state of ICD-10 awareness and implementation planning among staff. What we found was a little shocking.

Like a child worried about a monster in the closet, the majority of our responders felt that something bad was coming and that they wanted to do something about it, but had no idea where to begin.

Admittedly, ICD-10 absolutely is a good thing. The ability to describe a disease with a greater degree of specificity enhances any healthcare system’s ability to manage that disease. But inherent in any change, good or bad, are initial confusion, frustration and fear of failure if the change is mismanaged.

Our survey results indicate that many practices will be setting themselves up for failure if they don’t acknowledge the monster in their closet and find ways to deal with it.

Specifically, here are two of our survey’s more disturbing responses:

  1. “ICD-10 is just an IT issue and our vendor is taking care of everything.”

While your vendor will play an integral role in ICD-10 implementation, it is not the be-all, end-all answer. For example, your vendor cannot walk you through the day-to-day impact of implementation, covering everywhere a diagnosis code touches your practice.

Superbills, lab and X-Ray order entry, insurance pre-authorization of procedures and services, referrals to outside providers, home health treatment plans and myriad other areas all will require systemic changes to adopt ICD-10 coding. But more importantly, the human element requires understanding (“awareness and training”) of how the new coding system will impact one’s everyday world.

What about managed care contracts? Your IT vendor is not going to analyze your contract for areas in which reimbursement is tied to diagnosis and then schedule and conduct a renegotiation with your payer.

And what about retrospective reporting? As the former CEO of a large, multi-specialty practice, I relied heavily on benchmarking current performance against past YTD performance. Your vendor cannot help you understand how to compare ICD-9 apples to ICD-10 oranges.

  1. When asked how practices would use the General Equivalence Mapping system (GEMs) to aid in the ICD-10 transition, the majority of respondents were unaware of how GEMs function, let alone how it could help.

If there is a monster in your closet, using GEMs is an optimal way to neutralize it. In my opinion, after an initial practice impact analysis that determines where ICD-10 implementation needs to be emphasized, a useful GEMs tool is the perfect way to build awareness and training. Here are some of the ways we use an automated GEMs tool during our ICD-10 readiness consultations:

  • Immediately create ICD-10 awareness for staff and providers by teaching new code structure, identifying dramatic differences in documentation required to code to the ultimate specificity, and analyzing impact on day-to-day work processes everywhere a diagnosis code touches your practice.
  • Engage your doctors by developing quick-reference handouts (some call them “cheat sheets”) that help them understand new ICD-10 documentation and coding requirements. Develop a documentation “tips and requirements” sheet for each of your top 100 codes. Every week, give two or three of them to your providers to study. By the time the mandatory ICD-10 implementation date rolls around, your providers will be ready and they will thank you.
  • Enhance staff productivity during the transition. For example: ICD-9-CM contains only two codes for fracture of the patella (open and closed). Under ICD-10-CM there are 320 codes for fracture of the patella. Attempting to convert two ICD-9 codes to 320 ICD-10 codes manually would take hours. Using the GEMs Translator, this process takes seconds.
  • Perform mini chart audits by analyzing current chart documentation for adequacy when coding ICD-10 (a top AAPC executive reported that recent audits revealed that 40 percent of current chart documentation is unable to support ICD-10 codes). This is another great way to get your doctors engaged.
  • Renegotiate managed care contracts that contain payment provisions tied to diagnoses. For example, if an insurance contract contains reimbursement triggers for the diagnosis and management of diabetes, the contract will indicate an ICD-9 code for diabetes. Since the negotiation process takes many months, use GEMs to convert to ICD-10. Given the length of time it takes to renegotiate, the time to start is now, and you need a GEMs resource to help.
  • Start updating EMR chart note templates for ICD-10 documentation requirements by using GEMs to translate current templates into the narrative descriptions you need in order to code.

Specifically, in dealing with the monster here’s what you need to do:

  • With apologies to the kids, just because you haven’t looked in the closet to see if the monster is really there doesn’t mean there is no monster. Likewise, just because you haven’t performed an ICD-10 impact assessment yet doesn’t mean there is no impact. Performing this assessment is easy, but you need to do it now because there is so much that still needs to be done. Everywhere a diagnosis code touches your practice, there is impact, and that impact must be addressed. Make a plan, build a team and deal with it. Purchase an easy-to-use, affordable GEMs tool to help.
  • As far as external ICD-10 influences go, don’t wait for the rest of the world to queue up to call managed care plans, billing companies and IT vendors and ask about their plans for ICD-10. Start now, and require certainty and deadlines in their answers.
  • Beware of the 30,000-foot view workshops out there that are all concept and no concrete. Find educational resources that provide step-by-step guidance,  not fluff.
  • Build an ICD-10 implementation war chest. Estimates predict a 10 – 20 percent loss of revenue even if you do everything right during the transition. The rainy day you need to save for is closer than you think.
  • And finally, if you find out the monster in the closet is all too real and just too big to handle, get help. As tough as your job is right now, it’s about to get a whole lot harder because of ICD-10. A good GEMs tool and the sympathetic ear of others dealing with the same monster can help.

About the Author

Dennis Flint is director of consulting and educational services for Complete Medical Solutions. Dennis formerly served as the CEO of a large, multi-specialty physician group, a full service MSO and was a certified professional coder through AAPC. He has authored or co-authored numerous “common sense” practice management books and implementation manuals. Educated at the United States Air Force Academy, he had a distinguished career as an Air Force pilot flying numerous secret and sensitive missions.

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We are all aware that ICD-10-CM and ICD-10-PCS codes are around the corner and that, even now, changes are occurring to prepare for the Oct. 1, 2013, implementation. But, are we all aware of the code freeze that will start Oct. 1, 2011, and continue until Oct. 1, 2014, well after the transition of ICD-9-CM to ICD-10.

As we approach the upcoming transition, questions arise about the interim changes.  A few commonly asked questions and answers are provided below.

Is This Going to Affect My Facility/Practice?

Yes. Any organization that utilizes ICD-9-CM will be affected, as well as Medicare fee-for-service physicians, providers, suppliers and other entities who submit claims to Medicare contractors for procedures and services provided to Medicare beneficiaries in any healthcare setting.

When Will the Coding Freeze Occur?

During its Sept. 25, 2010, meeting, the ICD-9-CM Coordination and Maintenance Committee indicated that it had finalized the decision to implement a partial freeze for both ICD-9 CM and ICD-10 code sets. A schedule of implementation dates is provided below.

    • Last regular update not affected by the code freeze will take place Oct. 1, 2011.
    • Only limited code updates will be made for the October 1, 2012, update for both ICD-9-CM and ICD-10 code sets to capture new technology and new diseases.
    • Again, on Oct. 1, 2013, only limited code updates will be made to ICD-10 code sets to capture new technology and new diseases.
    • And, of course, the day we have all been awaiting: Beginning Oct. 1, 2013, there will be no updates to ICD-9-CM, since ICD-10 will be in place. ICD-9-CM will no longer be a HIPAA standard.
    • Regular ICD-10-CM updates will not take place until Oct. 1, 2014.

The ICD-9 Coordination and Maintenance Committee will continue to meet twice a year during the code-freeze time period. Remember that even though ICD-10 replaces ICD-9-CM on Oct. 1, 2013, the code freeze will still be in effect, which gives all of us time to prepare as well as identify needed codes within ICD-10 that have been missed during the implementation.

Although we still have more than a year until ICD-10-CM takes place, providers must start using the new version of HIPAA transaction standards known as 5010 by Jan. 1, 2012, since the current version 4010/4010A1 does not accommodate use of the ICD-10 codes.

Speak Up!

Those who are already preparing for ICD-10 have found that there isn’t always a diagnosis code that best describes a patient’s diagnosis or condition. During the ICD-9 Coordination and Maintenance Committee meetings, the public is allowed, and encouraged, to comment on whether or not requests for new diagnosis and procedure codes should be created going forward. This is the time for all of us to speak out about our coding concerns and opportunities for the ICD-10 implementation. For example, requests for new diagnosis and procedure codes should be submitted based on the need to capture new technology or disease.



Make the Choice to be Proactive

From this point forward, providers must decide whether they want to be proactive or reactive. Now is the time to make your choice about this—and, if you choose to be proactive, which you should, start preparing for ICD-10 now.

Preparation includes staff education and implementation on the process for the assignment of ICD-10 diagnosis codes. Here are a few steps that will get you started.

    • Evaluate your coders to identify whether they need more education in anatomy or physiology, which is required to appropriately assign ICD-10 diagnosis codes.
    • Check to see whether super-bills need to be changed to get ready for ICD-10.
    • Take the opportunity to be a public voice during the ICD-9 Coordination and Maintenance Committee meetings to ensure that new technology or diseases are captured for accurate diagnosis assignment.

About the Author

Patricia A. Shell is a senior healthcare consultant with Medical Learning, Inc. (MedLearn®), St. Paul, MN. She has more than 30 years of experience in billing, coding, and compliance.

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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.


Impact of Other Initiatives

Numerous entities are monitoring coding accuracy (i.e. Recovery Audit Contractors, Medicare Administrative Contractors, Medicaid Integrity Contractors and Zone Program Integrity Contractors). In addition, codes are now the basis for reporting core quality measures – a key to value-based purchasing, creating physician report cards and monitoring quality indicators. With this increased scrutiny of code assignments comes greater attention to the documentation in the medical record to support the most appropriate code assignment. If a coder has a question about the documentation, he or she must stop to send a query letter to the physician to obtain clarification. The creation and follow-up of additional query letters also reduces coder productivity.

An Action Plan to Improve Coder Productivity

    1. Put a process in place to monitor coder productivity by coder and record type. When recording productivity by record type, the following groups at a minimum must be included: inpatient, observation, emergency department, outpatient surgery, clinic, diagnostic services, rehabilitation, psychiatric and skilled nursing. Many facilities also have subcategories to distinguish inpatient records by service type and/or length of stay. Outpatient services also may be categorized by service type (i.e. gastroenterology, cardiology, radiology) or by whether facility and/or professional fee evaluation and management codes are required (or whether coding includes physician
      services or charge capture review).
    2. Study the workflow for the coding process. Is all critical documentation required to support diagnosis and procedure codes present in the record and recorded in a timely fashion? Is there clerical support to locate missing records, documents, etc.? Do coders have access to all aspects of the hybrid record system, including ancillary systems, ordering systems and nursing systems? Is the follow-up query process effective and efficient?
    3. Look into computer assistance to improve coder efficiency, document access, workflow, etc. If coders currently must access multiple systems in order to view all medical record documentation, consider software that will create a “single record view.” This software provides coders with a seamless look into multiple systems and only requires one sign-on process. Coder workflow software allows a manager to assign records or documents to be coded into a coder’s work queue.  Operating similarly to transcription workflow software, coder workflow ensures that the oldest, most cost-intensive and most complex records are routed to the right coder with the right skills and then tracked for completion. Computer-assisted coding also can review text documentation and provide coders with a list of suggested codes for review. These types of software have been shown to increase coder productivity and improve accuracy.
    4. Develop a plan for supplemental coding staff. Supplemental staff may be obtained by utilizing existing staff working overtime hours, by using PRN staff or by contracting with a vendor to provide coders (staffing services). An article in the March 2011 Healthcare Financial Management Magazine(1) addresses staffing for variable workloads.  While the article focuses on nursing services, a similar approach can be applied to any function that fluctuates with patient volumes. In applying the article’s advice to coding, a facility would staff to their average needs and augment high-volume periods with overtime or on-call staff (or vendor staffing services). A facility also may consider outsourcing the entire coding function or the coding of a specific patient type or patient service to a company that can provide both the efficiencies and effectiveness inherent in any well-managed, high-quality coding process.

Having a process in place to measure and monitor coder productivity can alert a director to a changes in the number of records that staff members are able to process. The impact of various changes can be determined and any alterations to staffing or processes can be implemented quickly to minimize negative outcomes (i.e. increased discharged, not final billed levels).

(1) Bryce, David J. and Christensen, Taylor J, “Finding the Sweet Spot, How to Get the Right Staffing for Variable Workloads”, HFM Magazine, March 1, 2011.


When a new regulation, service line or coding/abstracting system first is implemented, loss in productivity often is attributed to a learning curve. It is assumed that productivity will return to previous levels within a few weeks, or maybe months. However, while productivity tends to improve after a major change, it generally does not return to pre-change levels.  It is critical to have quality, detailed baseline production rates so productivity trends can be mapped across months and years. Any decreases can be measured and an action plan developed to accommodate the decreased rate of record completion.

The facility’s director of health information management or an outside consultant can provide productivity statistics and workflow analysis. Once this information is known, steps can be taken to streamline workflow and improve coder productivity.

For a number of reasons, coder productivity is diminishing. However, with careful analysis and an action plan to improve coder efficiency or meet the increased need for hours, facilities do not have to become victims of growing coding backlogs.

About the Authors

Cheryl E. Servais, MPH, RHIA, is Vice President of Compliance and Privacy Officer for Precyse. In her position at Precyse, Cheryl’s responsibilities include planning, designing, implementing and maintaining corporate-wide compliance programs, policies and procedures, and updating them to accommodate changes in federal and other regulations.  In addition, she oversees training and development programs related to ethics, compliance and patient privacy; develops and chairs compliance and privacy advisory committees at the Executive and Board levels; and takes an active role in professional organizations.

Cindy Doyon, RHIA, is the Vice President Coding Services and West Outsourced Accounts for Precyse. Cindy has developed Best Practices for many HIM Departments as well as performing many departmental assessments throughout the country.  She is active in AHIMA and the CHIA and SCHIA, serving on various committees and as President of CHIA.  She was named CHIA’s 2005 Distinguished Member.

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