Worrisome lack of coding accuracy in ICD-10 National Pilot

Medical coders certainly have their work cut out for them ahead of the ICD-10 transition if the results of the ICD-10 National Pilot Program hold true across the majority of healthcare organizations.  The general rate of accuracy when coding test claims in ICD-10 was 63%, with the lowest scores for specific codes hovering around 30% accuracy, says the full report released this week.

Problems ranged from an over-reliance on computer assisted coding, mixing up similar letters and numbers, and technical glitches with uploading and transmission of documents to issues with overworked coders, incomplete EHR documentation, and coders forgetting key aspects of ICD-10 that were not present in the ICD-9 code set.

The pilot experienced several significant setbacks even before the coders got involved.  The project had to be scaled down to eliminate financial transaction testing with payers and due to time constraints, and some volunteer providers struggled to find the staff willing to participate.  Some of the test documents were scanned upside down when presented to the coders, slowing them down as they tried to figure out the handwriting or EHR text.

Once underway, the testing revealed that the challenges inherent in educating coders to the degree necessary to prevent a slew of low-level mistakes are going to be significant for providers.  Some coders forgot to add procedure codes. Some skipped laterality.  Coders often confused a capital O with a zero, or an L with a one.

Fitting ICD-10 coding into their daily workload was difficult for many coders, who only averaged two records per hour, down from their usual four.“The ‘perfect storm’ will be quickly descending upon the healthcare system,” the report warns.

“It involves the intersection of many moving parts and multiple dimensions. This report confirms the critical importance of testing all technical, operational, and business processes well in advance of deadlines.”

The report suggests that providers avoid trying to convert ICD-9 codes to ICD-10 codes when training coders. Different hospital policies affected the complexity of cases – some hospitals code minor diagnostic tests, patient history, and radiology services, and some do not – which produced variations in the ICD-10 codes assigned to documentation. Providers should be aware that discrepancies are likely to occur, and should talk with their payers about how that may affect a bill.

“It took the highest level of commitment for all participants to engage their own staff and support this endeavor in light of the many competing priorities, demand for time, and resources,” the report concluded. “It took enormous effort, time, perseverance, organization, planning, coordination or schedules, orchestration of tasks and activities, creation of a sensible project plan, in-kind donations, and people resources to complete. Program leadership and commitment were key indicators to the success of the program. The pilot program is a decent predictor of what the healthcare industry would need to strive and aim for in order to accomplish the nation-wide ICD-10 conversion successfully.”

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