The “go live date” for ICD-10 is swiftly approaching and medical coders are preparing to work in this new classification system with as much confidence as possible. The coding universe as we've known it for so many years is changing and productivity is almost certain to change once ICD-10 is the industry standard. Which begs the question, how will the change to ICD-10 affect productivity? And how do we measure the changes?
I remember the years before the electronic record when many HIM Departments would have a designated shelf for “Records to Be Coded”. In those early days, coders would take a heavy arm load of records from the shelf at the start of their work day. As the hours progressed coders could see the uncoded records shift from one side of their desk to the other as they completed each record one by one. At the end of the day it was gratifying to see the stack of records abstracted and completed. The size of the pile of papers on your desk was all the measurement you needed.
Today’s electronic environment is much different. Not only are there differences in how much coded data is required, but also what elements are abstracted and how is this recorded. Generally, coders abstract POA, HAC, some PSI and many times Core Measures. Many facilities are also requiring their coders to either check the charges for services or enter charges altogether depending on what record type they are coding. Medical coders tend to be very detail oriented individuals which bodes well in securing accuracy for data entry. This method also streamlines the process while capturing as many elements as possible with minimal individuals interfering with the medical record.
The AHIMA e-HIM Coding Benchmark Workgroup and the 2007 Coding Benchmark Survey assessed the process of monitoring coding productivity. Kathy DeVault condensed this data in the article Best Practices for Coding Productivity Assessing Productivity in ICD-9 to Prepare for ICD-10 in the AHIMA Journal 7/2012. Kathy outlines what is commonly coded in the four main categories of medical records: Inpatient, Ambulatory, outpatient and interventional surgery and procedures, Emergency department (ED) and Ancillary testing. The article also discusses elements to consider for optimal coding performance what is usually coded and not coded in the various record types and the data points that are generally captured with coding and abstracting.
We, at himagine solutions also did a survey of our field coders who echo that there are many more elements abstracted today in an effort to capture data, streamline the process, assure the accuracy of input and have individuals with a “clinical eye” capture these data elements. In the electronic environment it is also very common for the coder to access 3-6 different systems to view all parts of the medical record. We all know that each “click” represents a moment of time and additional systems require separate logins and passwords and add to the time it takes to complete a record.
This, plus, the additional codes that many facilities require for studies, reports, and information that is provided at the state and national level all add to the complexity of coding and the time it takes to perform this accurately. The data that is coded today is used in such a large variety of areas and for much more than reimbursement. We have all heard about Big Data and are definitely experiencing this in HIM.
To sum up, productivity today is not as easily visualized as in the “olden days” before the electronic record. Coders felt a sense of accomplishment when we saw that large stack of medical records coded and ready to be routed to the physician’s incomplete area for a signature on the attestation sheet. It was a visual experience for them and they could easily measure what they completed that day. Today’s work environment is different. Coders have the ability to work remotely, must access multiple systems, and enter data in a variety of fields invarious programs. Not to mentioned that there are usually many records that require queries, CDI input, pre-certification or holds for a variety of reasons. It is an ever changing environment that keeps us all continually challenged in our efforts to learn and develop our expertise.
Now, where is that shelf entitled, “Records to Be Coded”?