# How many cases per day?



## mfanning

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!


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## jnewberry

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.


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## mfanning

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)?


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## mitchellde

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


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## jnewberry

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....


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## mfanning

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?


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## keke74

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!!


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## mfanning

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!


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## PURNIMA

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


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## jimbo1231

*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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## keke74

As I stated before 250/day I found to be impossible in the beginning, and my teamates and I did and still do express our concerns about this. Although more focus is being placed on meeting Quality metrics now , I feel this should have been the bigger focus in the 1st place. Although for the most part as a team productivity is high and quality work is produced, and thats not to say that we are all perfect, because there are times when procedures are missed which was 1 of the concerns we expressed due to such high expectation on productivity.


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## ercoder4u

I am an er coder and read your discussion, and I am interested in knowing if you get paid by the chart or by the hour?  also how many charts in a day are you all required for facility coding?  I have done both.


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## soccerdoc33

mitchellde 


Can you remember what the article is considering a Coder vs a Coding Specialist? 

Thanks!


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