How Will You Determine Coding Productivity?
Medical Coding is a function under the Health Information Management (HIM) department for many healthcare agencies. Monitoring all the functions within a department is needed to ensure quality and quantity of work is performed to expectations, therefore, measuring coding productivity is necessary.
Coding is ever changing. It really is. The transition from ICD9 to ICD10 was a huge transformation in 2015. ICD-10-CM codes are revised, updated, added, and removed twice a year. CPT codes are also updated annually. As medical treatment evolves – so must the coding of such treatment and this can have an effect on coding productivity.
The standards for measuring coding productivity prior to 2015 was pretty well set with very little variation. Benchmarks were covered by organizations such as American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC). I’m sure most HIM Administrators and Managers were thankful for that.
2015 also brought the mandatory conversion of paper medical records to electronic medical records (EMR). This can also affect coding productivity. Coders had to learn to navigate and review EMR documentation and then use different systems within the EMR to enter coding. I have seen an EMR where coders use 3 separate systems to complete the coding process for 1 encounter.
Coding responsibility also evolved – changes in process, reviewing and/or entering charges, reviewing modifiers, addressing denials, just to name a few. Coders still have to answer phone calls, communicate with billers on coding issues affecting billing, some attend denial meetings, new service meetings, ask assistance from managers, and sometimes need training as well. This is time not spent on coding but other related duties. Let’s not forget that there are times a coder must query the provider on conflicting information or unspecified diagnoses and so must wait for the provider’s reply before coding completion. We all know providers are not always timely and they do not always follow protocol as to answering a query. Many times coders review documentation only to find it still is waiting for additional documentation and must put the encounter on hold for coding pending documentation. Now, the coder has spent time on the encounter but is still unable to code and they will have to re-visit the encounter again when all documentation is present in the encounter to complete coding. How can a manager really assess coding productivity then?
There are many different perspectives of creating a matrix of acceptable coding productivity. I do think all elements should be explored and researched before finalizing your matrix, and also to review your benchmarks yearly to ensure they are acceptable.
Assess your coding team, sit with coders and review how they work and how they use the systems they code in. This is always beneficial to ensure the team is all on the same page and performing similar duties. Laying out the process simply gives the coder the advantage. Talk to coders and listen to their pros and cons of completing coding. They have legitimate concerns and sometimes solutions on workflow issues. Creating this team effort toward similar processes starts the coders on a fair atmosphere. Coders need to trust how they will be monitored on coding productivity and believe in the process on how to measure their productivity.
Managing an HIM department involves monitoring other activities and not just coding. Not all managers are certified coders but I do suggest to actually code and do the work a coder does as this helps in seeing all the nuances of the coding process. It also helps you to manage coding issues and understand them better. It helps you to learn the differences and similarities between encounter types and how that affects coding. It also will show you how fast or slow documentation flows to the encounter. By learning how you can streamline and assist in the coding process to get the coders as much as they need to do perform their job accurately and timely makes you a better manager and creates trust in your coders so that they know you understand the positives and negatives.
The next step is to decide on your encounter types. You can break it out in detail or generically. Encounters will fall between inpatient and outpatient. But depending on the organization and the types of encounters they service, this will help you to determine how specific you need to be in monitoring their coding completion. Here are a few examples of labeling different encounter types.
Inpatient:
Specialty (obstetrics, newborn, general surgery, orthopedic, critical care, trauma, medicine)
Long Term Care
Rehab
Behavioral Health
Lenth of stay factors
Outpatient:
Clinic
Imaging
Observation
Day Surgery
Oncology
Therapy
Take time to review the average time it takes for coders to complete the different encounters they code. Determine if you can bunch encounters together as they take the same time to code. Do your research to start building your matrix, and remember this can change over time. Remember to do your annual review of productivity especially if codes have changed, services have changed, and systems have changed.
Once you begin to see the coding productivity results, you can then compare them to standard benchmarks. How do your coders match up to national standards? Should you accept current productivity levels or should you push to improve results? Showing and discussing national standards with your coding team is beneficial to all involved. If you decide to improve and want higher standards from your coders, you will need a plan of action, and that plan will need the suggestions and buy in from your coding team. I believe they want to improve as coders but need to see the plan to succeed and believe in that plan.
Your coding productivity matrix is almost set and your coding team agrees to productivity expectations. The next step is not an easy one. Now, you must determine how to monitor their productivity. Can you obtain a report to show what a coder has coded? Not all EMR systems have a billing system built in. What system can you use to create a report of coding completion? Do you use the coding system or billing system? Does the report show you all you need to determine productivity? Many coders must keep a self-logged productivity list daily. Manual logging takes time from coding and can have errors. You may need to work with your IT Department to assist in creating a productivity report. When will it be run, how often is it run, and data needing to be tracked are elements to think about. Can you include the encounters a coder puts on hold is also beneficial to report on. Does the report show the actual time a coder started and ended coding an encounter? Most EMR systems will show the time of discharge compared to the time coding is completed. This does not tell me the actual time a coder took to complete coding.
Of all the different aspects of determining coding productivity, I have had more difficulty in creating an automated report to show the information needed to monitor it. You may have to settle for what you can get and decide on how to truly monitor your coding team’s productivity. I do believe EMR systems are evolving and improving for all sections of patient care and hopefully the reporting system will be able to provide an accurate report of all user productivity.
So, in recap, do your research. Research national standards. Work with coding team to understand their workflow and process, each coder is different but yet productivity averages can be determined. Agree together on how encounters will be counted toward productivity and then finalize on your matrix. Decide how often you will monitor productivity and hopefully a report can be used to do so. And don’t forget to review your matrix at least annually to determine if revisions are called for.
