The fact a coder shortage exists is certainly not breaking news, but the fact is the shortage is getting worse.  One of the contributing factors is the increased requirement for reporting and other government-payer-related problems.  The impact on receivables for providers is serious with a backlog of uncoded charts in the queue.

Productivity is of course a factor in any job function, but with the advent of the ICD-10 code system, another layer of reporting will further impact coding output.  Those who are considering a career in the healthcare field, medical coding and/or billing Billing-Coding Combo should now seriously consider training as a coder.

The main factors affecting product include the following:

Present on Admission
The additional time required to enter the present-on-admission (POA) status of each diagnosis code is now required.   In 2007, the Centers for Medicare & Medicaid Services (CMS) launched a new initiative to classify codes to indicate whether the condition represented by the code was present at the time of admission or whether it developed during the hospital stay.   The POA code is assigned to the ICD-9-CM code.  The reason is that CMS uses POA data to address conditions that developed during hospitalization that would impact on the Medicare reimbursement calculation.

New Reporting Requirements
The 5010 claim form in place on January 1, 2012 allows providers the option to submit more diagnosis and procedure codes, now up to 24 diagnosis codes  (previously was 9) and up to 24 procedure codes (instead of the former 6).  The idea is to provide the opportunity to increase information submitted to support medical necessity.  The time for coding will proportionately increase as more information is elicited and submitted.

With the current emphasis on quality of care, the addition of secondary diagnoses codes provides a more complete picture of the severity of illness. Coders limited to six codes often had to choose to either omit codes for ancillary procedures or for some procedures in complex trauma surgeries.

Codes are now the basis for reporting core quality measures – a key to value-based purchasing, creating physician report cards, and monitoring quality indicators.

Current Procedural Coding (CPT)
With the shift for outpatient provider coding to formerly inpatient coders, the need to learn CPT coding has become acute.

Auditing increases:  Recovery audit contractors, Medicare administrative contractors, and Medicaid integrity contractors monitor coding accuracy.  With this increased scrutiny of code assignments, medical record documentation to support what is coded has magnified the need for good records.  If documentation is missing, coders must now do the additional research.

Recent Production Study Results
A recent study and review designed to measure productivity was performed on coders doing a large volume of inpatient records.  The framework was to tabulate the difference in the average number of charts coded per hour in 2009 vs. 2010. In 2009, the coders completed a total of 64,107 records, an average of 2.38 inpatient charts per hour. In 2010, the average dropped to 2.1 inpatient charts per hour, a decrease of nearly 12%.   As you can see, the average record coded in 2009 was 17.85 per day and in 2010, 15.75.  If projected to apply to code hour requirements, it would indicate an additional 20 hours of work per month PER CODER to achieve the same result.

If the provider fails to expand the coding personnel, the claims backlog would grow proportionately.  To make the numbers more dramatic, after the first month, 40 charts would remain uncoded.  With the average
reimbursement at $6,000 per record, the first month’s loss of current receivables is almost $250,000.  Multiply that on a per coder basis at a large institution, and the numbers look pretty awful. A provider with 4 coders = $1 million!

Improving Productivity
Ways and means to establish and monitor coder productivity by coder and by record type is a good first step.  Grouping by category, e.g., inpatient, observation, outpatient surgery, clinic, diagnostic, rehabilitation, psychiatric, and skilled nursing, etc.  Even additional subcategories might be included to distinguish inpatient records by service type and/or length of stay.

Outpatient services may also be categorized by service type (e.g., medical specialty), whether facility and/or professional fee evaluation and management codes are required, whether coding includes physician services, or charge-capture review.

It is critical to have detailed baseline production rates so productivity trends can be mapped over months and years.  Decreases may then be measured and action plan developed to accommodate the differential.  Often, the “learning curve” is the x-factor, projecting that when the curve is complete, production will return to former levels; however, that is rarely true.

Software helps:  Coder workflow software allows a manager to assign records or documents into work queues. Operating similar to transcription workflow software, it ensures that the oldest, highest-dollar, and most complex records are routed to the appropriate coder and tracked for completion. Computer-assisted coding can review text documentation and provide coders with a list of suggested codes for review. These types of software have been shown to increase coder productivity and improve accuracy. uses the Alpha II coding system with great success. Alpha II Coding Software

Staffing for variables in workload capacity is clearly important.  Rather than anticipate high volume and overtime, outsourcing may be the best option.  Outsourcing the entire medical coding operation is not uncommon. have provided outsource coding services since 1989.