Medical coders participating in an ICD-10 coding pilot produced accurate coding using the complex new system less than two-thirds of the time, according to a report by two healthcare IT industry groups.
Accuracy rates varied widely by type of medical condition coded. For example, a case of acute gastritis without bleeding was coded accurately 100% of the time in one batch or “wave” of test results, while “chest pain, unspecified” was coded accurately in only 34% of records tested in a different batch.
The 54-page report (PDF) presents the results of the national pilot program begun in April and completed Aug. 30 that included all participants in the claims processing cycle—including more than 30 provider organizations, as well as software systems vendors, health plans, billing companies, claims clearinghouses and the government. The research was conducted by the Healthcare Information and Management Systems Society and the Workgroup for Electronic Data Interchange.
Lisa Gallagher, vice president of technology solutions at HIMSS, warned it would be unfair to blame the coders for any negative results. “It didn’t mean the coder didn’t know what they were doing,” she said. “It may have meant the medical documentation was not precise” and subject to differing interpretation. “It was a process. If we say the coder made a mistake, that’s not an accurate way to portray it.”
In the real world, “there are all kinds of supporting functions that end up influencing how a document is coded,” Gallagher said. With ICD-10, “you’re moving to a place where there is so much specificity in how things are coded. They may not know they need to provide documentation to a coder to reach a certain granularity.”
Healthcare providers from across the country donated de-identified patient medical records for use in the project. The records for a selected number of test cases were then coded using ICD-10-CM (clinical modification) and ICD-10-PCS (procedure coding system) by volunteer coders from various organizations who had been approved by the American Health Information Management Association. They produced a repository of ICD-10 coded records, representative of the most common medical conditions in healthcare, to be used as an answer key. Copies of the medical records for these test cases, stripped of their coding, were then accessed by pilot participants for their coders to read and code.
