"Coding Update"

Problems with ICD-9 Codes Contribute to Coder Shortage

Slow progress toward U.S. adoption of ICD-10, More providers are outsourcing coding

ALTHOUGH ICD-9 IS CONSIDERED inadequate to effectively meet the needs of today’s healthcare system, a number of hurdles prevent implementation of the proposed ICD-10 codes.

Of equal significance is another problem intertwined with the inadequate ICD-9 coding system: a nationwide shortage of coders. A 2001 survey by the American Hospital Association revealed an 18% vacancy rate for coder positions, compared to an 11% vacancy rate for nursing.

“The task of keeping up with rapid—and often illogical—changes to ICD-9CM while navigating often-inconsistent reporting rules has become so onerous, and the scrutiny on coded data so intense, that many qualified coders have left the field,” observed Rita Scichilone, Director of Coding Products and Services at the American Health Information Management Association (AHIMA) in Chicago, Illinois.

Tracking The ICD-10 Story

Some pathologists and laboratory directors have been tracking efforts to convert to ICD-10. But overall, this story has received little mention in the lab industry trade press, despite the implications of final conversion to the ICD-10 system.

The replacement system to ICD-9- CM is ICD-10-CM and a related procedure classification, ICD-10-PCS. In 1994, the World Health Organization adopted ICD-10 and this system is now in use in Europe. Unlike ICD-9, which is built on a five-digit numeric code structure, ICD-10 has a seven-character code length. This expanded structure is designed to accommodate new procedures and new technologies for many years into the future.

The United States is probably two years away from launching implementation of ICD-10. Meanwhile, to cope with the shortage of qualified coders, a growing number of providers are turning to outsourcing as a solution. Within this country, providers are establishing off-site coding centers. However, the more interesting development is the increased use of off-shore contractors to handle coding.

As well, a number of information technology companies are developing automated coding products. There is even research into ways to map codes to standardized medical nomenclature, such as SNOMED-CT.

Lab managers and pathologists should begin to track progress on the implementation of ICD-10 codes within the United States. The time is approaching when all healthcare providers, including laboratories, will need to devote management time and resources to the issue of ICD-10 and decide how to best introduce it into their own organizations.

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