It's not exactly a surprise, but with all the emphasis on being financially prepared, getting software updated and running, and training staff on the new codes, a shortage of experienced coders who are both certified and competent to handle the ICD-10 coding system has come as just another irritation in the complex and occasionally frustrating transition to the new system.
"As a hiring manager of a coding department (staff of 22 for 160-180 providers), I had positions open for six months or longer," said Barbie Hays, coding and compliance strategist for the American Academy of Family Physicians. The problem is not always simply finding someone with the appropriate credentials. As everyone is learning, the change to ICD-10 is challenging on many levels. Working with the new codes takes more time and being successful in today's changing healthcare world requires equal measures of patience and enthusiasm.
There is more to successful coding than simply memorizing a set of codes, no matter how complex. All the billing experience in the world is useless if you aren't comfortable with the new codes. "Applicants would be newly credentialed but with no experience. Or vice versa," said Hays. "A coder may know black and white coding rules and guidelines, but have no experience with billing and reimbursement or they may not show the passion that I demand from my team."
The transition from ICD-9 to ICD-10 has caused some logistical problems in coder staffing as well. "With the delay of ICD-10 until 2015, schools were graduating people with ICD-10 certification and no knowledge of ICD-9," said Jennifer Perry, practice administrator for Norwood Clinic, a large multispecialty practice based in Alabama. "Most current coders who initially certified on ICD-9 have obtained their ICD-10 certification. However, ICD-10 has significantly disrupted workflow because the coders have to look up every code. Many had so many of the old codes memorized that rarely used the ICD-9 book."
Some practices are outsourcing their coding and if the company is carefully chosen, this can be a good solution, especially if you expect your need for extra coders to be temporary. For many practices, however, the solution is closer to hand and potentially less expensive. If you have an upcoming opening for a coder, or have a coder who is planning to retire, Perry suggests that you invest in your current employees. "Send a great employee to training classes," she suggested. "Classes are available online, where you can work at your own pace, or through a semester class at local community colleges. We have done this in the past with awesome results."