Coding Contest Lends Insight Into Accuracy, Productivity

Central Learning, a web-based coding assessment and education application, released the results of the second annual nationwide ICD-10 coding accuracy and productivity contest. The announcement was made by Manny Peña, RHIA, founder and CEO of AVIANCE parent company, Pena4, Inc.

Ashley Sparks from San Marcos, Texas, and Cynthia Procter from Temple, Texas, each received a $2,500 prize for achieving the highest average accuracy scores for their assigned inpatient and outpatient cases respectively. Over 550 coders registered to code 1,636 cases during the August 2017 coding contest. Central Learning automatically scored ICD-10 accuracy and productivity levels using real medical record cases against a vetted, standardized answer key based on published coding guidelines.

Created with feedback from 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. In addition, a video providing step-by-step instructions was made available to all registrants.   

"Although a slight improvement in inpatient and emergency department accuracy improvement was realized, the ambulatory surgery accuracy score decreased," Peña says. "These results demonstrate that the medical coding industry still needs to greatly improve in order to achieve a respectable and acceptable ICD-10 and CPT coding accuracy level. The contest data reflects a true outcome and provides the ability to benchmark data from last year's contest."

Contestants coded their cases in Central Learning which simulates a true medical coding environment using real and complete medical records. Codes are entered into a Coding Grouper, just as coders do today in real-life coding.

The following key findings were released:

• Average inpatient coder accuracy: 61%
• Average outpatient coder accuracy: 41%
• Breakdown—average ambulatory surgery coder accuracy: 45%
• Breakdown—average emergency department coder accuracy: 36%
• DRG accuracy: 72%, overall financial net impact of -$753.91 per case
• RAC DRG focus accuracy*: 35 %
• Coding productivity per hour: inpatient cases 2.5/outpatient cases 4.8
• Higher productivity decreased coding accuracy by -25.4%
• Higher productivity decreased outpatient coding accuracy by -20.3%

Based on Central Learning contest data, the following steps are recommended for HIM directors and coding managers:

• Continue assessing coder knowledge in ICD-10 and CPT coding.
• Provide targeted ICD-10 education and training to address knowledge gaps.
• Supplement internal coding reviews with monthly external coding audits.
• Balance coding productivity and accuracy performance metrics.
• Monitor coding denials from payers—predicted increase in 2017 fourth quarter and 2018.

Full contest results and more detailed information will be available at Booth #346 at the 2017 AHIMA Convention & Exhibit. Learn more at www.centrallearning.com/codingcontest.

*Office of Inspector General Reports Highlight Hospital Billing Issues, MLN Matters Number: SE17017, Initial Article Release Date: September 7, 2017

Source: Central Learning