Did you know there’s a competition to determine the “best” coder?  The 2nd Annual ICD-10 Coding Contest took place July 14 - August 11, 2017.  Central Learning sponsored the coding competition and recruited coders from all over the nation to participate in coding a total of 1,636 real medical record cases. Ninety-nine percent of the participants were certified coders. The inpatient coders who participated had an average of 14.3 years coding experience while the outpatient coder experience averaged 9.9 years. Complete results of the competition can be found at http://journal.ahima.org/2017/10/06/2nd-annual-icd-10-coding-contest-results-sponsored/.  If nothing else, it contains valuable information regarding the “state of the union” for ICD-10 CM/PCS accuracy and productivity, two years post ICD-10 go-live.

The most recent competition results were revealing, with an average inpatient coding accuracy score of 61% percent, and even lower outpatient score. The 95% accuracy scores used as benchmarks for ICD-9 are pretty far out of reach.

Things to consider:

• There are now more than 150,000 ICD 10-CM/PCS codes
•  Hundreds of additional codes for both diagnosis and procedures are added yearly
• Coding education is sporadic with coders reporting no regularly scheduled ICD-10 CM/PCS education
• Coding education is expensive keeping it out of reach for some coders to fund themselves
• The Official Guidelines for Coding and Reporting are changing yearly
• Coding Clinic from AHA continues to publish coding instruction quarterly but have had many corrections published over the last two years
• Official direction on some ICD-10 update questions is sluggish

These are a few examples of the challenges coders face when attempting to increase their ICD-10 coding accuracy and productivity. The ICD-10 coding system is growing and maturing. Coders must have the opportunity to grow and mature their skills at the same time. Without it, coders are left feeling frustrated and confused.   After all our hard work over the years to prepare for ICD-10, how can the accuracy scores reaming this low?

Cornerstones to your 2018 Improvement Plan:

Tackling ICD-10 CM/PCS accuracy and productivity issues through education and auditing, is still the most efficient way to garner consistent improvement. Utilize both internal and external audits to maintain progress. 

Quality: Accurate reimbursement is dependent on coding quality. Your entire coding team should be certified by AAPC or AHIMA. Upcoming coding challenges are more complex than ever and are ever changing. An accuracy benchmark of 95% is your optimal goal with multi-specialty experience for your team. Coding errors increase the risk of audits and financial penalties. High standards for coding accuracy should be part of your organization’s compliance plan.

Motivation:  Every good leader knows that motivation is key to employee performance, productivity, and a culture of learning. Leaders must set good examples. Remember, your attitude is contagious. If you meet the ongoing challenges of ICD-10 CM/PCS with an attitude of “we can do it,” most of your staff will too. Your positive attitude and encouragement will help your staff feel needed, appreciated, and valued.

Education:  Education of ICD-10 is ongoing, with new coding guidelines and code system updates for both ICD-10 CM and PCS. Interpretation of the new codes and guidelines must come from approved resources and in conjunction with the Cooperating Parties, not individual coders.   One of the best ways to ensure accurate interpretation is with American Hospital Association’s quarterly Coding Clinic. Your institution’s coding education plan for 2018 should contain new items on the agenda, such as: hierarchical conditions coding, secondary diagnoses coding, and coding related conditions. CPT coding has received the lion’s share of attention in physician services due to the reimbursement model. ICD 10 CM diagnosis codes will determine payment under HCC models and need greater detail with more specific documentation than ever before.

While the 2017 competition revealed a somewhat ominous state of affairs, it just highlights the absolute necessity of investing in continued education and training in the fluid world of ICD 10 coding.

About The Author

Laura Legg

HIM SPECIALIST

Laura Legg, RHIT, CCS, CDIP, AHIMA Approved ICD-10 CM/PCS Trainer, has over 30 years of health information management experience working with acute care hospitals, critical access hospital, and home services.  Laura has worked closely with HRG's HIM department and many healthcare providers nationwide.