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  ICD10 Watch
by Tom Sullivan

After ICD-10, will coders ever regain ICD-9 efficiency levels?

If anyone is suggesting that ICD-10 will not create a productivity drop in the days after compliance, they must be practicing silent protest. Most experts agree that come the flip-switch October 1, 2013 compliance deadline even seasoned, well-trained coders will take longer with the ICD-10 than they did with ICD-9. The overarching question is whether or not coders will master ICD-10 and, in so doing, resume ICD-9-era productivity?

An expanding camp of healthcare experts and industry bodies is answering that question with a definitive “No!” The AAPC (American Academy of Professional Coders), for instance, posted an article last week, ICD-10 Impact on Productivity, explaining the causes of lower productivity, and saying that “productivity will not return to normal upon implementation. There will be a delay as we assess how the payers interpret the new coding system.”

[Related: Will ICD-10 spark coder chaos? See also: HIMSS11 takeaway: ICD-10 tricky, and just a start.]

Why? Greater specificity, new documentation, an increase from five to seven digits, are just some of the reasons.

“There will be a learning curve that comes with ICD-10; the codes are very different, the guidelines have changed in some areas, and we are going to be communicating with physicians more closely to make sure all the necessary information is available,” the AAPC states in its article. “Initially, we will have to learn all the new guidelines and coding processes. Today, the codes are still considered 'unstable' and are subject to change prior to implementation.”

Last October, Cynthia Grant, director of Canadian consultancy Courtyard Group, said that productivity in Canada, which has already adopted ICD-10, never bounced back to ICD-9 levels.

There's simply no way around the time it takes to use more codes and more digits, to achieve that greater granularity.

AAPC's Reid says that success rate of ICD-10 – including coder productivity levels – will vary based on how providers plan for and ultimately harness the new codes.

“I think there are so many unknown factors there,” Reid adds in an email to ICD10Watch. “The sooner people begin the preparation process and start changing the way they document and code, the more quickly they will 'bounce back' from the changes. I do expect that the U.S. will bounce back from the changes, but how long that will take is yet to be seen…”


In my opinion it will take a

In my opinion it will take a lot of time to regain efficiency. Remember, how overwhelming was Present on Admission(POA) when it came into effect for IP coding! Eventhough hospitals did their job of providing training to stakeholders, it still took more time for coders to code charts. They had several practical questions as they started coding hand on charts. Few months later they started adjusting and becoming more comfortable with this change. ICD 10 is going to be a big change for all coders with biggest impact on Inpatient coders who will need to learn both CM and PCS side of ICD 10. With ICD 10 implementation, they will be looking for additional information in the chart for more specificity which will take more time. If there is lack of documentation, they will have to spend time on asking Physician queries. ICD 9 experienced coders remember ICD 9 codes by heart which will not be the case in ICD 10. They will also be looking to become familiar with ICD 10 coverage policies. Spending time on training themselves with ICD 10 will also contribute to intial drop in prooductivity.

At some point in the process

At some point in the process the clinical data has to be captured. Why not programmatically convert clinical data to the applicable ICD-10 code as part of the process? Hasn't AI programming come far enough now to accomplish at least part of the task?

CAC may be able to play a

CAC may be able to play a role to boost productivity for less complicated records such as basic radiology. But for more complicated IP cases, experienced coders will be required. The key for provider organizations is to prepare well in advance for the productivity hit, both short and long term. Review educational needs, staffing and contract in advance for additional coding support for before and well after 10/1/13.

I accept there will be a

I accept there will be a short term productivity hit. I can accept there will be a forever hit. I don't accept that someone cannot at least give us a range of how bad the hit will be (e.g., 40%-55% for 30 days, 25%-40% for another 90 days, 15%-25% forever. How else can we plan for the additional resources to get work done?

I don't mean to be too

I don't mean to be too flippant, but surely this productivity "issue" must fall into portfolio of ObviousMan (for any of you who, like me, follow the comic strip Non-Sequitur).

As Mr. Sullivan correctly points out, ICD-10 is NOT just ICD-9 with different codes, it is a new, much more detailed process of both documentation and coding. It's like asking whether asking caregivers to wash their hands before examining (or operating on) patients affects productivity. Of course, it does! It makes the procedures safer, but it adds extra time that will never be recovered, just as collecting and reviewing additional documentation will "slow us down" in the ICD-10 world. Let's move on, folks....

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