Twenty percent. Fifty percent. Forty percent.

With each passing month, a new survey confirms what health information management (HIM) professionals already know. Coder productivity decreases as a result of ICD-10 implementation — before, during and after. All coding hands need to be on deck for assessments, training, dual coding, testing and implementation. However, day-to-day coding in ICD-9 must be maintained to ensure cash flow and revenue integrity. Backup coding resources are needed — but from where? The answer is complicated.

At the recent Health Information and Management Systems Society (HIMSS) ICD-10 Symposium in New Orleans, speakers described the migration from ICD-9 to ICD-10 as a “dimmer switch” rather than an on-off button. The initial ramp-up to ICD-10 aside, the need to manage day-to-day ICD-9 functions will linger far beyond the Oct. 1, 2014 deadline. While this requirement to maintain two coding staffs is a big concern for HIM departments, it is an even bigger obstacle for IT professionals to maintain dual software applications and databases. Concerns abound.

Three staffing strategies have surfaced in recent months, and all were discussed by HIM professionals attending the HIMSS symposium. Attendees agreed that these strategies should be explored now, in 2013, and they added that a tactical plan must be devised for backup ICD-9 coders. There is no time to wait and see what peers are doing. Coding staff must be augmented immediately. This article lays out these three possibilities.

Keep a Few Coders Focused on ICD-9

Coder meetings have been held. Skills have been assessed. Some training has begun. By this point, HIM directors should know which coders will embrace ICD-10. They also should know which coders are dragging their feet. Where possible, leverage pockets of coder reluctance into long-term ICD-9 resources. Keep a few ICD-9 coders on staff and well-incentivized to:

  • Manage payor denials.
  • Work recovery audit appeals (multi-year lookback periods require ICD-9 know-how).
  • Analyze data and compare trends across systems.
  • Support long-term research needs.
  • Perform multi-year quality reporting.
  • And more!

Outsource ICD-9 Backlogs

The demands of ICD-10 education, training and dual coding take experienced ICD-9 coders out of action. While some organizations have adequate staffing to absorb the resultant backlog, others do not. One strategy is to outsource a portion of your ICD-9 coding in 2013, establishing a strong resource pool for coding backlogs to be available in 2014.

KLAS® Research produced a survey titled “HIM Services 2012: Weathering the Storm” in December 2012 (the report is available to providers at According to KLAS, “one-fourth of providers are increasing their use of outsourced coding in their organizations.” Action must be taken now to secure an outsourcing partner, whether remote or on-site. Act right away or you’ll pay later in the form of higher outsourcing fees, delayed assignments and diminished coder skills. Here are three questions to ask:

  • Can you ensure adequate coding coverage now and through the transition phase?
  • What are your internal quality controls and QA requirements? Do you provide QA reports to clients?
  • Can you guarantee a specific turnaround time?

Finally, consider outsourcing services provided by those payors that are not mandated to use ICD-10. At this point, these include workers’ compensation and automobile accident insurance. These cases also would represent a good application of your “holdover” ICD-9 people. The logistics of keeping two systems running side-by-side within your HIM department are frightening — outsourcing your ICD-9 coding is a simpler solution.

Cast a Wide Net

Even outsource coding companies will find themselves short-staffed as we approach the Oct. 1, 2014 deadline. Many are looking overseas for new coding talent. Taking their cues from the medical transcription industry, such coding companies are investing time, money and resources into building offshore backups. They are taking the lead and making sure offshore coding partners are safe, reliable and available.

The good news is that offshore partners’ skills, technology and quality have skyrocketed during the past decade. Foreign coders are well-versed in ICD-9 and ICD-10. Communications, reporting and security controls all have been enhanced as well.

Ask your coding vendor if it is partnering with an offshore firm. Most of them are. Here are three key questions to ask, in addition to those listed above.

  1. What is your staffing complement size, and what are their credentials?
  2. What is your coding QA process, and is a copy available for our review?
  3. What is your IT infrastructure, and are there backup systems and a security plan?

Cost of Delay is Your Biggest ICD-10 Risk

There will be no single solution to spikes in ICD-9 coding volumes resulting from the migration to ICD-10. Organizations already are experiencing ICD-9 backlogs when existing coding staff is taken offline for assessments and training. Dual coding will add another layer of unsupported workload. It is time to identify an organizational strategy and solidify your tactical plan. The overarching message is clear: act now or pay later.

About the Author

Karen M. Karban, RHIT, CCS, is the director of coding integrity for HIM On Call, where she leads all company coding initiatives and helps support customers as they transition from ICD-9 to ICD-10. She holds multiple certifications through AHIMA, including RHIT, CCS and approved ICD-10-CM/PCS trainer.

Contact the Author

Karen M. Karban, RHIT, CCS,

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