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Anderson Reveals “Scary” Truth About ICD-10 Test Results

Written by Kaitlyn Houseman | October 16, 2013

The North Carolina Healthcare Information and Communications Alliance executive director Holt Anderson revealed a ‘scary’ finding after some end-to-end ICD-10 testing.  Anderson made the announcement of their findings during the MGMA 2013 annual conference last week.

Anderson explained the testing was to see where coders are at and to share experiences with others in order to better prepare providers.  Unexpectedly, for 20 dual-coded and peer reviewed scenarios, the first wave resulted in 55% accuracy with many scenarios falling below that.  Wave two came with better results averaging to a 63% accuracy rate.  However, “single, live births born in hospitals, delivered by Caesarian section were 100 percent coded wrong,” said Anderson.  Through peer review, they realized the coders weren’t coding correctly in ICD-9, let alone ICD-10.

The cases were actual clinical cases being coded by what Anderson says “some of the best of the best.”  Anderson considers NCHICA to be further ahead of the game than most considering their more than 300 member organizations and established coding task force.  So far the task force has conducted more than 200 dual-coded and peer-reviewed scenarios, and another 100 scenarios are still in the process.

Though the coding proved to be inaccurate throughout the testing, another main concern is the time it was taking just to complete a medical record.  Coders were averaging two medical records per hour with ICD-10 compared to four or more under ICD-9. 

With ICD-10 proving to be a difficult task while taking twice as long, Anderson urged providers to “group up” and “get on it” or they will face a significant issue with cash flow.

Behind schedule? 

According to an American Health Information Management Association analysis published earlier this year, hospital ICD-10 implementation efforts are either non-existent or still in the initial stages.  In June, MGMA reported that just 4.8 percent of more than 1,200 responding medical groups had made “significant” progress in their ICD-10 implementation efforts.  MGMA recommends that medical practices plan for 16 to 24 hours of training for the clinical staff and 40 to 60 hours for coding staff.

With 5x the code set increase, everyone from the appointment scheduler to the physician needs to understand that specific documentation, medical necessity, and third-party payer guidelines are imperative to a successful ICD-10 implementation.