Medical coding service involves documentation, assigning appropriate codes, and developing a claim to be paid by Medicaid, Medicare or a commercial payer. Accuracy is a key factor in coding medical claims, as these codes enable the insurance payer to understand the illness or injury of the patient and the method of treatment, and decide whether to reimburse or deny the claim. Central Learning’s 2nd Annual National ICD-10 Coding Contest results provide evidence that the average inpatient medical coding accuracy shows slight improvement. Published recently in the Journal of AHIMA, this contest results revealed that the average inpatient coding accuracy has increased 6% between 2016 and 2017.
This report also compared the average inpatient and outpatient department coder accuracy.
Unlike the first annual ICD-10 contest, this year’s contest included sample cases for coders to familiarize themselves with the Central Learning application prior to competing and a video providing step-by-step instructions was made available to all registrants.
Over 550 coders registered to code 1,636 cases during the August 2017 coding contest. Key findings of the contest results include average coding accuracy details.
- Inpatient coder accuracy was 61%, up from 55 % in 2016 and average outpatient coder accuracy was 41%
- Accuracy in ambulatory surgery centers was 45% in 2017, which is slightly lower when compared to 46% in 2016.
- Accuracy in the emergency department was 36%, up from 33% the previous year.
- DRG accuracy for five new cases in 2017 was 73% and 71%, compared to 72% in 2016.
- Coding productivity per hour: inpatient cases 2.5/outpatient cases 4.8
- Higher productivity decreased coding accuracy by -25.4% and outpatient coding accuracy by -20.3%
Although a slight improvement can be noted, the ambulatory surgery accuracy score decreased. Also, there is room to improve further to achieve a respectable and acceptable ICD-10 and CPT coding accuracy level.
Several areas in which low code accuracy was noted include “congenital malformation, deformations and chromosomal abnormalities;” “diseases of the skin and subcutaneous tissue;” and “certain infectious and parasitic diseases.”
Based on the contest data, some steps that were recommended for HIM directors and coding professionals and entities such as medical coding companies include:
- Continuous assessment of coder’s knowledge in ICD-10 and CPT coding
- Providing targeted ICD-10 education and training to address knowledge gaps
- Supplementing internal coding reviews with monthly external coding audits
- Balancing coding productivity and accuracy performance metrics
- Monitoring coding denials from payers
Sarcoma Coding Is Still Inaccurate
Though the ICD-10 contest results published recently in the Journal of AHIMA shows improvement in inpatient coding accuracy, there are certain rare conditions for which medical coding is still not perfect as recommended by coding guidelines. Sarcoma is one such condition. According to the study results presented at the Connective Tissue Oncology Society Annual Meeting, ICD-9/ ICD-10 coding for sarcoma is inaccurate, and affect the accuracy of the National Cancer Data Base, National Inpatient Sample and other national databases.