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A Look at Post–ICD-10 Coding
By Jagdish Kumar, CCS, CCSP, CPC, CPMA

In examining coding practices following the ICD-10 transition, we have observed four major areas that have experienced considerable impact: production, backlogs, denials, and risk management.

Productivity Losses
Many productivity issues have been caused by changes in documentation, where there's now a need to dig for further specificity.

With ICD-9-CM around for 30 years, many coders were able to assign codes for the most frequently used conditions from memory. Now, that's not possible for even a single code.

Although training was conducted prior to the ICD-10 transition, coders must update their knowledge of anatomy and physiology terminology to keep pace with the expanded clinical information.

Production may also be suffering due to incomplete physician documentation, forcing coders to search deep into medical records to finalize the accurate level of detail to code correctly.

Radiology departments are probably most affected by the move to the new codes, with 50% of the 69,000 ICD-10 codes being musculoskeletal and another 25% focused on fractures.

Temporary Production Loss at Transition Phase
Permanent Production Loss
Physician Coding
20% to 35%
Radiology Coding


Coding Backlogs
Because coders are requiring more time to assign ICD-10 codes, there is 15% increase in backlogs. A shortage of coders well versed in ICD-10-CM may be the most significant factor behind the productivity loss.

The Centers for Medicare & Medicaid Services (CMS) has reported 10% increased denial ratios following the ICD-10 transition. This has resulted in more time and effort being spent on reworking charts for reprocessing. As a result, physician practices may suffer a negative impact on their cash flow and revenue due to lost productivity and an increase in coding errors.

The major reasons for denials have been invalid/incomplete data and incorrect ICD-10 codes.

Risk Adjustment
Under ICD-9, CMS made medical assistance payments through hierarchical condition category (HCC) codes. ICD-10 is also based on HCCs, with the conditions remaining the same. However, the number of diagnosis codes increased by more than 5,000.

For example, most of the malignant codes for neoplasm are further classified with specific body location and laterality. Diagnosis codes also have been added to diabetes mellitus.

Jagdish Kumar, CCS, CCSP, CPC, CPMA, is general manager of coding for Vee Technologies. He has 16 years of experience in HIM and revenue cycle management with specialization in medical coding (physician and hospital) and expertise on billing and denial management for hospitals, clinics, ambulatory surgical centers, and physician groups, along with clinical data improvement for ICD-10-CM/PCS and bill reviews for payers.