Coding Complex Cases in ICD-10: Ways to Improve Quality

by | Oct 26, 2017

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Complex Medical Coding ICD-10 Cases

Complex inpatient encounters often involve new, experimental surgical procedures. Most common in academic medical centers, these coding cases create hurdles for coders and medical coding management. Managers may need to forego the push for productivity while coding professionals take time to conduct research, ask questions and assign the correct codes.

When it comes to complex coding cases, flexibility and critical thinking skills are required to ensure correct reimbursement capture and mitigate the risk of denied claims.


Encouraging coding professionals to engage their critical thinking skills when ICD-10 medical coding complex cases or new, experimental procedures is paramount. Here are three ways to begin:

  • Help coders understand the entire coding picture through critical thinking combined with knowledge of anatomy, physiology and pharmacology.
  • ” Encourage an investigator mentality and thinking outside the box when performing research to ensure medical coding ICD-10 accuracy.
  • Build knowledge and consistency among team members—share research required to code complex cases.

In the January 2018 issue of the Journal of AHIMA, I will provide five strategies to help HIM leaders build a critical thinking mindset across ICD-10 medical coding teams.


Taking the time to conduct research, ask questions, and code complex cases right the first time versus repeating efforts when a claim is denied or rejected by the payer is always preferred. However, medical coding managers must allow flexibility in their medical coding productivity standards.

When coders spend time to research cutting-edge medicine, coding productivity may be slowed in order to ensure correct reimbursement and avoid claims denials. A proven strategy is to flex productivity benchmarks for complex medical coding ICD-10 cases. Consider the following tactics:

  • Use length of stay (LOS) as basis for adjusting medical coding productivity standards on complex cases.
  • Look at total charges for new, highly complex surgical procedures when lower LOS occurs.
  • Consider using a combination of LOS and total charges to adjust coding productivity standards.

A critical thinking mindset, coupled with flexibility in coding productivity expectations, promotes collaboration as coding professionals and medical coding managers tackle new challenges and learn new skills to advance the coding profession.

Please let us know what types of complex cases your coding team faces, and what strategies you employ to support a critical thinking mindset.

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