How the Health Information Management Industry Will Be Impacted by the ICD-10 Transition

ICD-10 productivity impactMention the ICD-10 transition to a health information management (HIM) team and one word is likely to come to mind: productivity. There are approximately five times the number of codes in ICD-10 than in ICD-9. Disease classifications will be in the double digits. Inpatient hospital procedure codes alone will increase from 3,000 to 87,000 codes in ICD-10. It is inevitable that a greater quantity of codes combined with a ballooning volume of patients – the Affordable Care Act will bring nearly 40 million people into the healthcare system – will challenge HIM plans, procedures, and productivity. Which means there is one more important word to add into this mix: prepare.

By now, all healthcare entities should be well into preparation mode in anticipation of the October 2015 switch to ICD-10, finessing their operations in order to be in compliance with ICD-10. This involves not only adapting to new software and the new codes, but also updating procedures with which doctors report their diagnoses and recommended treatment to coders so that billing is carried out properly.

Originally slated to go into effect in October 2014, the ICD-10 launch date has been delayed a year. But this change doesn’t mean organizations have the luxury of slowing down in preparation for compliance. The more time you have to prepare means, simply, that you have more time to practice – every HIM professional should be taking advantage of this opportunity of more time to assess and reassess how new procedures are working, where the gaps are, and where confusion remains so productivity rates are not at a drastic deficit come October 2015.

How Low Could Productivity Really Go?

Phoenix Health Systems carried out three studies about how ICD-10 will impact coding productivity, coming to the conclusion that hospitals should plan for nearly a 50 percent reduction in productivity in the first three months of ICD-10 with their current coders. Coding productivity will improve over time – potentially leveling out at 80 percent of ICD-9 levels by October 2016, according to Phoenix – but the learning curve is steep and, if HIM teams and coders want to avoid errors, they will need to work carefully and focus on precision and accuracy for every case. And that takes time.

Procedure Coding System (PCS) is expected to be the biggest hurdle and biggest slowdown for coders. These are codes that must be built, which means medical documents must be interpreted by coders and ultimately assigned multiple PCS codes for one procedure. Hence, the need for significantly increased educational requirements for coders in the areas of anatomy, physiology, and medical terminology, and greater specificity by doctors and nurses in writing diagnoses and ordering procedures.

Using ICD-10 standards, Health Revenue Assurance Associates (HRAA) subject matter experts have been coding 1.5 inpatient charts per hour, three same-day surgery charts per hour, and five emergency department charts per hour, the latter two including both CM and PCS, a far lower productivity standard than with ICD-9.

Current Productivity Issues? ICD-10 Is a Complication, Not a Solution

Productivity loss will be impacted by the skill level of current coders, the complexity of cases and patients, and the amount of time that’s been dedicated to educating coders for ICD-10 and allowing them to practice. This falls on the shoulders of every healthcare organization’s HIM staff. HIM professionals are responsible for leading the transition to ICD-10, as well as evaluating, educating, implementing, and maintaining compliance with this new system. The entire coding workforce must be retrained to use ICD-10.

If there are efficiency problems now with ICD-9 that are affecting productivity, ICD-10 will only compound these issues, not fix or eliminate them. Insufficient documentation, high denial rate, weak denial management strategy, and software problems are all issues that can negatively impact coder productivity and ICD-10 adds another factor to decrease productivity even more.

Productivity and the Bottom Line

Incorrect billing and coding can be the ruin of any medical practice or healthcare entity. Inaccurate coding can lead to unsubmitted claims and a precipitous drop in reimbursements. There is no excuse for not preparing for ICD-10 as diligently and carefully as possible to maintain accountability and profit.

Productivity loss because of ICD-10 implementation is a very real danger, especially to the HIM department, because a coder’s main job responsibility is to determine the correct codes for billing – and reimbursement – purposes. It’s crucial to properly identify ICD-10 diagnosis or procedure codes – unfamiliarity with this system makes an already more complex system far more difficult to adapt to.

It is inevitable that there will be an increased coding backlog as it will take longer to assign codes in ICD-10. The days of assigning codes from memory will be over. The only option at this point is to forge ahead and prepare your coders for ICD-10. Assess current productivity, implement a dual coding plan (and track results), be prepared to outsource coding or, if possible, hire more coding staff (alternately, outsource current coding needs so that current staff has more time to practice with ICD-10).

Conducting quality audits and compliance auditing after the ICD-10 rollout will also benefit any HIM team and healthcare organization. Consult with Provident Edge for technology solutions and assistance with ICD-10 readiness.

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