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As hospitals prepare to implement ICD-10, they increasingly are kicking the tires of computer-assisted coding software in an effort to take pressure off coders who expect to be overwhelmed with the massively larger sets of codes comprising the International Classification of Diseases and Related Health Problems 10th Revision.

Traditional coding software replaced coding books and acts like an electronic book. A coder no longer must leaf through a book, but scroll through lists to find an applicable code and enter it into the encoder.

ICD-9 has approximately 18,000 codes; ICD-10 has around 140,000, according to the Centers for Medicare and Medicaid Services. So scrolling, already an exasperating task with I-9, simply isn't going to cut it with I-10 without a major reduction in coder productivity-if the coders hang around. "We've already had two people retire with ICD-10 coming," says Sue Trewhella, associate vice president of revenue management at Geisinger Health System in Danville, Pa. "ICD-10 is the biggest issue bringing computer-assisted coding forward."

Computer-assisted coding, or CAC, software analyzes documents and generates codes based on specific phrases and terms within the document. The secret sauce is the use of natural language processing technology to identify key terms and phrases

The software also analyzes the context of the wording to determine if a particular instance requires coding. For example, the software can deduce if the term "cancer" is being used as a diagnosis and needs to be coded, instead of being used in a different context, such as a physician noting a family history of cancer.

Coders initially don't view computer-assisted coding with any less apprehension than they do ICD-10, Trewhella says. "The biggest issue with staff is that they were convinced they were going to be replaced by a machine," she says. "I had to convince them that computer-assisted coding was a way to support expansion and keep experienced staff." Another pitch was the expectation of reduced overtime to get back to a work-life balance. "We're not there yet, but it's something to look forward to."

A feature story in the September issue of Health Data Management explores the challenges that providers face and the benefits they realize when implementing and using computer-assisted coding software.