January 15, 2013

The Coding Education 10,000–Hour Rule

By

The 10,000-Hour Rule is just that: the idea that it takes approximately 10,000 hours of deliberate practice to master a skill. “Outliers: The Story of Success” is a book written by Malcolm Gladwell, and a fascinating read that I highly recommend.

Throughout the text, Gladwell repeatedly mentions the 10,000-Hour Rule, claiming that the key to success in any field is, to a large extent, a matter of practicing a specific task for an extended period of time. I do not think 10,000 hours is a precise figure, but shorthand standing for “lots and lots of dedicated practice.”

For instance, it generally would take approximately five years of full-time employment to become proficient in many fields. Applying this logic to the coding arena, I would say it takes about five years of experience for coding professionals to reach a high level of coding proficiency.

I am not seeking to debate the 10,000-Hour Rule or how attributes such as critical thinking skills, rational decision-making and analytics skills contribute to the success of a coding professional. Nor am I stating that it definitely would take any coder five years to become proficient in ICD-10 coding. I will, however, provide my thoughts on why organizations should begin providing ICD-10 coder training sooner than later.

Invest in Yourself

Better invest in your most valued coding resources – or someone else will. Possessing more than 27 years of coding experience, I can provide a veteran point of view on the subject of coding professionals, education and the coding process. While I am confident that experienced coding professionals will make a successful transition from ICD-9 to ICD-10, less experienced professionals may find the transition more difficult.

Productivity and quality will be impacted due to the learning curve associated with the new coding system. Anyone who believes that these metrics will be the same with ICD-10 as they were with ICD-9 likely does not understand the complexities of the coding process. As coders gain more experience with ICD-10, it is expected that this impact will decrease, however. How long and to what extent the learning curve will impact productivity and coding quality is dependent on individual coder training, coder experience and coder knowledge retention with the new system.

A common theme among some organizations is discussion of the topic of when to begin training coders. Sadly, far too many providers have elected not educate their coders “too early,” as they are concerned the coders will leave once they are trained. Instead, organizations are planning to train coders six months before the go-live date, with the assumption that the coders will all be fully trained and ready for ICD-10 coding in October 2014. Keeping in mind that learning is a continuous process and that people learn at different speeds, hoping this “just-in-time” training approach will result in the desired outcomes is not a strategy I would recommend.

How to Train and Retain Your Coding Staff

Coding professionals are in demand now, and the demand will be even stronger in the future. Many organizations are challenged by recruiting experienced coders, coding managers, supervisors, auditors etc. Nobody wants to hire inexperienced coders, as is evident by the numerous posts from new graduates looking for a first coding job. The reality is that continuous training and education is part of the present and will be an even more critical part of the future. Understanding that the health information management (HIM) department and the coding process are the middle of the revenue cycle, organizations must approach educating these critical personnel as follows:

  • Coders learn and perform best in a positive environment where they feel respected and confident. Lose sight of this and they may be coding for someone else before long.
  • Coders have different learning styles that must be taken into account. The goal is not merely to provide education, but to ensure that the coders retain the new knowledge required to excel at ICD-10 coding.
  • Coders are motivated by information and tasks that are meaningful and applicable to their jobs. Include them in the process of developing the education curriculum. No one wants to be talked at during education sessions.
  • Coders prefer training and education that focuses on real-life problems. Provide education that is relevant. Provide detailed education that is focused on the disease process and surgical procedures. Provide a deep understanding of what coders are doing before you provide education on how to assign a code.

To quote Aristotle, “We are what we repeatedly do. Excellence, then, is not an act, but a habit.”

In other words, practice, practice, practice.

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.

Contact the author

To comment on this article please go to

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.

John Pitsikoulis, RHIA, is the ICD-10 practice leader and an AHIMA ICD-10-Approved Trainer for Nuance Communications. John has more than 28 years of revenue cycle, health information management, coding, and compliance consulting experience. John has developed and led several corporate and client strategic engagements for managing the conversion to ICD-10, including ICD-10 assessments, implementation planning, integrated testing, education plan management and revenue preservation strategies.