After many delays, ICD-10 coding has become a reality. There were several reasons for the challenging transition. The false starts were very, very costly to healthcare organizations and others such as billing companies who serve the industry. Training people in ICD-10 was, and remains expensive, with delays caused significant problems. People were without jobs, leaving the coding market to find employment elsewhere. Others were laid off due to no need. Some older ICD-9 experts decided to retire versus learn the new system. Contracts were written with service organizations and then broken. And those were only a few of the issues that healthcare businesses faced, and continue to face early on in the new era of medical coding.
Now that ICD-10 is fully implemented, the challenges continue finding coders, maintaining consistency, ensuring accuracy, managing costs and staying compliant. The transition from ICD-9 to ICD-10 dramatically increased code specificity. ICD-9 has 3,824 procedure codes and 14,025 diagnosis codes, while ICD-10 has 71,924 procedure codes and 69,823 diagnosis codes. That is an increase in procedure codes of nearly nineteen times and diagnosis codes of about five times. The new system may not have increased the workload or resource requirement linearly with the number of codes, but surely, the overall increased resource requirements were noticeable. At a time when reimbursements are shrinking, rising costs only add pressure to the system.
The grace period for auditing, quality reporting and leniency ended in 2016 and compliance is now required. Guidelines require providers to code reflecting clinical documentation as specifically as possible. Accurate coding of claims requires correct clinical documentation. Coders are unable to assign proper codes when documentation is incorrect or lacking, which results in claims being rejected by the payer or insurance company. That means that healthcare organizations must make certain that coders are prepared to keep up with the requirements. This requires additional training, supervision and an ability to learn the increased coding responsibilities quickly and efficiently.
The Bureau of Labor and Statistics projects that medical coding jobs will grow 15 percent from 2014 and 2024. The average growth rate for all occupations is seven percent during that same time. The cost implications and financial pressure seem insurmountable at times as the gap between reimbursements and cost continues to widen. According to the AAPC, in 2016, the average annual salary for medical coders ranged from $49,452 to $52,320. With the increase in the nation’s aging population, along with the implementation of ICD-10, there is and will continue to be an added demand for medical coding professionals to assist the provider community with the increased patient encounters.
Add to that a growing depletion of the United States medical coder pool and the increased challenges with greater financial consequences for hospitals and physician networks. Let’s not forget the increased pressure on seeing more and more patients by physicians. How might that effect accurate clinical documentation? If rushed, documentation errors could possibly increase, thus requiring more coding assistance and clinical documentation improvement; further increasing cost.
As a consumer, I am concerned about quality of care. There are no easy answers, but cost containment and optimal reimbursement from payers are crucial to ensuring high quality of care. That is why providers and service organizations are turning to off-shore companies to provide resources at far lower costs to complement or plug holes in their coding resource pool. ICD-10 has been implemented far longer in countries such as the Philippines and the labor pool is much larger and well trained. A medical coder from the Philippines would likely cost much less than half of a U.S. based resource and could help significantly fill in the gaps that organizations currently have, while improving operating margin.