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Thread: How many cases per day?

  1. #1
    Join Date
    Apr 2007
    Posts
    24

    Default How many cases per day?

    Hi -

    I am new to ED coding & will be doing it for the physician service. Can anyone tell me about how many cases you code per day?
    I am trying to get an idea of what a reasonable expectation is.

    Thanks so much!

  2. #2

    Default

    This is a most difficult question to answer. It depends on what type of records you are coding. Are they dictationed, ERM, etc. How many pages are your records. Is it a group with good knowledge of what to document and how to document so that you are not wasting time going over parts of the record you do not need to go over, etc, etc, etc.

    Some coders can read faster then others. Some have been in the medical field of perhaps nursing and undertand the charts just as if they are standing next to the physician and taking the physicians orders.

    Some computer work-stations are user friendly and then others are not. So........
    as you can see threre are many things that can vary.

    I know of a billing service that requires 230 charts per day. I know of one that requires 200 per day. But I know lots of coders and if you want a good days work from them .....150-175 per day is a good amount of charts without errors.

  3. #3
    Join Date
    Apr 2007
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    24

    Default

    What is the quickest way to determine the level of service if I am reading dictated charts? Are physician ED coders expected to go through each note and "score" all of the elements (history, exam, MDM)?

  4. #4
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    11,902

    Default

    Here is an except from an article on coder productivity, pretty accurate I think:
    Suggested Productivity Levels* for Coding Career Ladder

    Coding Specialist I:
    > 45 inpatient records** daily
    2 min/chart or 250/day outpatient and ER records
    3.5 min/chart or 130/day ambulatory surgery records

    Coding Specialist II:
    > 32 inpatient records** daily
    2 min/chart or 250/day outpatient and ER records
    4 min/chart or 120/day ambulatory surgery records

    Coder II:
    > 23 inpatient records** daily
    3 min/chart or 160/day outpatient and ER records
    6 min/chart or 80/day ambulatory surgery records

    Coder I:
    > 15 inpatient records** daily
    4 min/chart or 120/day outpatient and ER records
    8 min/chart or 60/day ambulatory surgery records

    * For coding and light abstracting. Assumes an eight-hour day/40-hour week.
    **Regardless of payer type and case complexity

    (table/courtesy Rose Dunn)

    TABLE 2:
    Productivity Levels According to Other Sources
    Productivity Level
    3 to more than 10 inpatient
    records/hour with the majority at 4-7 records per hour
    Source
    Medical Records Briefing, Where Do You Stand? A Collection of Benchmarking Articles,
    10 to more than 31 outpatient records/hour with the majority at 11-20 records per hour
    Medical Records Briefing, Where Do You Stand? A Collection of Benchmarking Articles,
    20-60 inpatient records/day
    36 Medicare records/day
    46 non-Medicare records/day
    53 ambulatory surgery cases/day
    140-344 ER/outpatient tests/day
    Journal of AHIMA, Productivity
    Standards: A survey of HIM professionals, Part II

    Debra A. Mitchell, MSPH, CPC-H

  5. #5

    Default

    There is a huge difference in coding the professional side "vs" the facility side. I am sorry.... I think I understood the original question. I was thinking that you were talking the professional side....

  6. #6
    Join Date
    Apr 2007
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    24

    Default

    I am talking about the professional side & still can't understand how a coder can assign so many E&M codes per day!!

    Someone told me to use the clinical examples found in CPT for ER as the starting point then quickly check my history & exam "points" to make sure the documentation is there.
    So a patient with chest pain is assigned a 99285 initially and may need to be down coded if the history & exam score isn't up to snuff. Does this sound like an acceptable approach?

  7. #7

    Default

    I'm an ED Coder and only code the Professional services & the company I work for Productvity standards are 250/day, however now there's more focus on meeting Quality metrics, in which we do. In the beginning I didn't see how that was possible either, but once you get use to it, it can be accomplished, however as jnewb stated it all depends on what type of charts you get, # of pages, dictation, or T-sheets. Its easier when you have those providers that use the T-sheets. To answer your question in reguards to scoring all of the elements as an ED coder, yes you should to determine the appropriate level of service. Hope this helps!!

  8. #8
    Join Date
    Apr 2007
    Posts
    24

    Default

    It seems crazy to expect a physician coder to code 250 ER charges per day! Perhaps I will get faster with time.
    Thanks for everyone's help!

  9. #9

    Default

    Hi,

    An ideal target for a physician coder -ER coder would be around 150-160charts/day. Suggesting the coder shoudl take 2-3 minutes per chart adn for a 8 hour working period, coder achieves 150charts, without comprimising on QUALITY!

    Thank You,

    Purnima S

  10. #10

    Default 250 seems a bit high

    This is always an intersting discussion. Oddly my experieince has been that EMRs and middleware in some cases have slowed down coding since the coder is dependent on system speed, user friendliness, screen flips etc. Also there is coding and there is Coding. Meaning many coders are required to do a number on non coding key strokes...time in and out. I've even seen some have to enter insurance info. I've also seen very streamlined coding systems that coders can code more quickly through with front end scrubs and edits to speed them up. But I agree with Purnima that 140-160 is reasonable. I would be concerned about quality at 250 especially missed procedures..
    Purnima, How are you? Think we worked together for a short time.

    Jim Strafford

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