HIMagine That! Coder Agreement

June 19, 2015 / By Sue Belley, RHIA, Donna Smith, RHIA

Donna: Sue, what results are you hearing about ICD-10 coder agreement as sites get ready to implement October 1, 2015?

Sue: What do you mean by “ICD-10 coder agreement?”

Donna: Well, as hospitals are in the homestretch of their ICD-10 preparation activities, one of the things they’re doing is having all of their coding staff code the same cases in ICD-10 so they can compare results.

Sue:  Okay – I wanted to make sure we’re talking about the same thing. I’m hearing that coding managers are getting some surprises.

Donna:  Really? What kind of surprises?

Sue:  For one, they are finding that their coding staff aren’t consistent in what they code and report. They’re realizing that they need to review and update their coding policies. You know, this really isn’t related to ICD-10 – it’s just a basic coding issue. It just reinforces what we’ve been saying – now is the time to take a critical look at internal coding policies and procedures and overhaul them accordingly. It’s a task that always seems to fall to the bottom of the to-do list with the competing priorities of the day.

Donna:  So true! The other day I received an email from a coding manager who asked for guidance on coder agreement – seems she is getting some pushback from the coding staff when discussing the cases they’ve coded and comparing results.

Sue:  Pushback? Seriously? What did you tell her?

Donna:  I said this is to be expected. I asked her when was the last time she compared coding results among coders in ICD-9 and discussed the differences. Of course, nobody really does that in ICD-9, so I told her that you have to expect this to be an uncomfortable process for all involved. The majority of coding professionals do not have the same comfort level yet with ICD-10 that they have with ICD-9, so it makes sense that there would be a lot of questions and discussion.

Sue:  Spot on, Donna. It’s the nature of the business . . .

Donna:  Yes! In fact, this coding manager noted that “coding is an art and a science!”

Sue:  You know, coding professionals are justifiably very proud of their work. And, they’re very detail-oriented and can go to great lengths to provide the reasoning behind the codes they’ve assigned. Not all coders see a record in the same way which leads to variation in coding.

Donna:  I suggested to this coding manager that she take a step back and remember that the reason she initiated this coder agreement project was to identify ICD-10-CM/PCS coding concepts, situations, procedures, etc. that are not well understood so those could be remedied with the staff. I just read about a study where the tester had 100 people code the same Coronary Artery Bypass Procedure. They were able to identify the characters of the PCS code that were most problematic for the coders. This allowed the organization to deliver targeted education to the staff. Then, when the group was retested there was significant improvement.

Sue:  I hope people see the value of comparing coding among staff members and continue to do that now, during and after the transition to ICD-10!

Sue Belley, RHIA, and Donna Smith, RHIA, are project managers with the consulting services business of 3M Health Information Systems.

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