Preparing for ICD-10-CM/PCS implementation: impact on productivity and quality

Area of Science:

• Health Informatics
• Medical Coding Systems
• Healthcare Administration

Background:

• The transition from the International Classification of Diseases, Ninth Revision, Clinical Modification/Procedure Coding System (ICD-9-CM) to the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) presented significant challenges for healthcare systems.
• Estimates of productivity loss during this transition varied, highlighting the need for empirical data on coding efficiency and quality.

Purpose of the Study:

• To compare coding productivity and interrater reliability between ICD-9-CM and ICD-10-CM/PCS for hospital inpatient cases.
• To identify factors influencing coder productivity during the ICD-10-CM/PCS implementation phase.

Main Methods:

• A comparative study analyzing coding times and interrater reliability for hospital inpatient records coded using both ICD-9-CM and ICD-10-CM/PCS.
• Cases were matched for complexity and severity to ensure a fair comparison.
• Statistical analysis, including two-tailed T-tests, was used to assess differences in productivity and reliability.

Main Results:

• Coding inpatient records with ICD-10-CM/PCS took an average of 17.71 minutes (69%) longer than with ICD-9-CM (p = .001).
• Coder experience and education level did not significantly impact productivity, but more extensive training suggested a positive return on investment.
• Interrater reliability was substantial for ICD-9-CM but only moderate for ICD-10-CM/PCS, with increased time per case not necessarily correlating with higher quality.

Conclusions:

• The study confirms a significant decrease in coding productivity during the ICD-10-CM/PCS transition, potentially underestimating previous projections.
• Investments in comprehensive coder training are crucial for mitigating productivity losses and improving coding quality.
• Guidance on time management per record is essential, as increased coding time does not automatically ensure higher accuracy or reliability.