Will computer-assisted coding help mitigate productivity losses in ICD-10-CM/PCS?

 

On October 1, 2014, hospitals, physicians, and all other healthcare providers will transition from ICD-9-CM to ICD-10-CM—a new and more specific diagnosis code set. Acute care hospitals will also begin to use ICD-10-PCS for inpatient procedures. Coding professionals who currently assign procedure codes using ICD-9-CM Volume 3 must learn how to report procedures using ICD-10-PCS.

 

ICD-10-CM/PCS offers greater specificity and accuracy; however, because of this specificity and accuracy, coders will have many more code choices. ICD-10-CM includes more than 68,000 diagnosis codes, and ICD-10-PCS includes more than 72,000 procedure codes.  

 

Coding professionals must work with healthcare practitioners to ensure that documentation is complete and specific. Such documentation will enable coding professionals to report ICD-10-CM/PCS codes accurately.

 

 ICD-10-CM/PCS codes provide the ability to measure healthcare service quality. Coding professionals and CDI specialists must work together to ensure that patient records reflect the quality of care provided. This requires physician education both before and after ICD-10-CM/PCS implementation.

 

Many administrators fear loss of productivity.. As with all new processes, there is always a learning curve. Studies have shown that when some Canadian hospitals implemented ICD-10-CA in July 2002, their inpatient coding productivity dropped by more than 50% (i.e., from 4.6 charts per hour to fewer than 2.15 charts per hour). This decline may require an increase in workforce resources, some of which will likely be limited shortly after ICD-10-CM/PCS implementation.

 

What can hospitals do to mitigate the anticipated decrease in productivity?

 

Yale New Haven Hospital in New Haven, Conn., proactively addressed this question. During AHIMA’s Clinical Coding Meeting in September, Cynthia Gaillard, RHIA, CCS, associate director of HIM at Yale New Haven, and Amy L. Wood, CPC, outpatient coding manager at Yale New Haven, gave a presentation about their hospital’s use of computer assisted coding (CAC) to boost coder productivity. Gaillard and Wood said that when the coding function was consolidated and moved to the hospital’s corporate office, administration began to explore tools such as CAC that would maximize coder productivity and accuracy as well as prepare coding professionals for ICD-10-CM/PCS.

 

CAC is best defined as software that automatically generates a set of medical codes for review, validation, and use based upon clinical documentation provided by healthcare practitioners. This software offers several advantages when compared with manual coding performed by a coding professional. Some of the most recognized advantages include:

Most CAC systems use a natural language processing (NLP) engine to review a patient’s record for diagnoses and procedures that coding professionals should submit for billing. Larger CAC vendors use exclusive and proprietary engines; however, all processors include technology that’s based on thecurrent:

 

This allows the CAC system to follow certain guidelines and rules when determining which codes to assign based on physician documentation provided in the health record.

 

The coding professional is instrumental in the CAC process. After the CAC engine processes the record, the coding professional must review the suggested codes to determine whether they are appropriate and make any revisions, as necessary.

 

When coding professionals make revisions, the NLP engine learns and processes these revisions using artificial intelligence. Coding professionals can easily see the terms that the CAC engine selected for coding as well as the exact place within the documentation from which the information was cited.

 

Coding professionals don’t need to review the entire medical record when coding. They are, however, required to link the final codes to the abstracting system. To do this, they can either simply click a submit button (for systems with an interface) or manually enter the codes into the organization’s billing system.

 

The transition to CAC may be difficult for coding professionals. In the beginning stages, they may find it challenging to abandon a familiar process (i.e., reviewing the entire medical record). However, once the facility provides appropriate training, and coders have used the system for a couple of months, the facility or provider should begin to notice an increase in coder productivity. Productivity will continue to improve over the next several months as users become more comfortable with the CAC process.

 

At Yale New Haven Hospital, inpatient coding professionals experienced a 15% increase in productivity during the first three months after implementation in the inpatient setting, according to Gaillard and Wood.

 

The hospital uses CAC in the outpatient setting for ambulatory surgery, interventional radiology, and heart/vascular center outpatient procedures. For these procedures, outpatient coding professionals experienced a 10% increase in productivity during the first three months after implementation in the outpatient setting. Coders experienced a 12% increase only a few months later.

 

When asked about how Yale New Haven Hospital plans to prepare for a potential decrease in productivity, Gaillard said, “As a health system, we can’t afford that much downtime, and we think the computer-assisted coding software will help us prepare for the decrease.”

 

Most CAC vendors acknowledge that it will take between six and 12 months for a CAC system to demonstrate a consistent increase in productivity. Some vendors boast that coders will eventually experience a 30%-50% increase in productivity.

 

If your organization is considering CAC as a remedy to offset productivity losses in ICD-10-CM/PCS, it really should implement it soon. After all, there’s only approximately a year and a half left before the compliance deadline. Hospitals that implement CAC will surely be prepared for ICD-10-CM/PCS, and coders will be able to breathe a sigh of relief in the meantime.

 

Editor’s note: Angie Comfort, RHIT, CDIP, CCS, is the director of HIM Practice Excellence at AHIMA in Chicago. Reach her directly atangie.comfort@ahima.org.