Necessary Time for Coding of Diagnoses in Ambulatory CarePDF german translation / full article
Background: The projected implementation of an ICD-10 coding guideline in ambulatory care (“ambulante Kodierrichtlinie”, AKR) led to questions about additional workload. Two descriptive studies were initiated and supported by the Association of Statutory Health Insurance Physicians Hesse (Kassenärztliche Vereinigung Hessen, KVH) in spring 2011.Methods: HEISA-1: comprehensive survey in ambulatory care about ICD-10 coding. HEISA-2: following study in the subgroup of experienced AKR users in HEISA-1. Both studies were coordinated, data pseudonymized and evaluated by an independent research organisation (PMV Research Group).Results: 1843 (20,5 %) of 8947 physicians in ambulatory care in Hesse answered the first questionnaire. ICD-10 coding is mainly a task for doctors – exclusively in 1707 (61 %) and in the majority of cases in further 405 (24 %) of the offices. In HEISA-2, a subgroup of 97 doctors returned additional questionnaires. Coding time took about 30 seconds per diagnosis. After implementation of the AKR, doctors and staff needed more than twice this time. This equals about 30 minutes additional daily workload.Conclusion: More exact coding requires additional time from doctors. Before implementing further bureaucratic instruments (such as the AKR), opportunities for cost and workload reductions in other areas should be demonstrated.