Many Agencies Pay A Lot For In-House ICD 10 Coding. Meanwhile, Your Profit Margins Continue To Shrink. Make The Change Today. (Part 2)

April 16, 2022

In part 1 of our ICD coding series, we looked at an overview as to why smaller agencies can’t afford to do in-house coding. In part 2, we will look at the dollars and cents of coding in-house. If you currently have employees in this role, have you broken down the true cost to your agency and determined productivity standards?

Cost And Productivity Of In-House ICD 10 Coding:

When we think of productivity in our agencies, we normally talk about clinical employees. Many agencies to not track the number of charts individual coders complete or monitor accuracy in a meaningful way. An RN who is certified in Oasis D and ICD 10 coding should be able to code 12 charts per day or 60 charts per week. If your in-house coders aren’t completing 240 charts a month, you may need to ask why. Our numbers come from a nationwide outsourcing company with many nurse coders on staff. It should also make you ask why you have multiple coders if your admission numbers don’t justify it. It is not uncommon for us to see several in-house coders for agencies with 200 admissions or less. So, let’s do math on cost.

The national average according to Zip Recruiter for an RN who is Oasis D and ICD 10 coding certified is $67,571 base salary. If you consider the average overhead rate of 34% of salary ($22,974), then your overall cost per coder is $90,545. Now, this is just the average. So, we realize there are agencies paying less and agencies paying a whole lot more. The same nationwide agency providing productivity numbers stated it is not uncommon for their coders to be paid $78,000 for base salary. Based upon this number, an in-house coder would cost a total of $104,520 ($78,000 base salary + $26,520 overhead). Now, let’s break these costs down for your agency numbers.

Based on the national average of $90,545 ($67,571 base salary + $22,974 overhead):

1. An agency averaging 100 admission per month is actually paying $905.45 per chart for a coder of this caliber.

2. 150 admissions per month cost the agency $603.63 per chart for the coder.

3. 200 admissions per month cost the agency $452.72 per chart for the coder.

4. 250 admissions per month cost the agency $362.18 per chart for the coder.

5. 300 admissions per month cost the agency $301.81 per chart for the coder.  

If we look at these same numbers based on the $78,000 base pay with overhead to total $104,520, the numbers look like this:

1. 100 admissions= $1045.20 per chart for coding

2. 150 admissions= $696.80 per chart for coding

3. 200 admissions= $522.60 per chart for coding

4. 250 admissions= $418.08 per chart for coding

5. 300 admissions= $348.40 per chart for coding


Kenyon Homecare Consulting charges $65 for ICD coding and Oasis analysis/ review. Based upon those numbers and the level of expertise and certification, you need to do the math for your agency. If your RN coder is doing 240 admissions per month and is certified and accurate, your in-house coding may work well for you in a cost analysis. In our experience, agencies doing 240 admissions per month with in-house coding normally have several coders on staff. So, the costs for your coding department go up drastically. You may be paying the national average of $90,545 for three or four coders to handle your admissions. Suddenly, you are paying between $271,635- $362,180 per year just to keep your ICD 10 coding in- house.  Those same admissions done by Kenyon Homecare Consulting's RN Coding Specialists will save you anywhere from $76,635-$167,180 per year to complete 250 admissions per month.

Let Us Be Your Choice For ICD 10 Coding:

At Kenyon Homecare Consulting , our ICD 10 coding department works with agencies to help them improve documentation and get the dollars they deserve to service patients. All our coding staff are Oasis and ICD 10 certified RNs who know our industry and the requirements in documentation. Call us today at 206-721-5091 or contact us online to see how we can help you save money and still receive excellent coding accuracy and efficiency.

Results Based Consulting

Did you find value in this blog post? Imagine what we can do for your home care or hospice agency. Fill out the form below to see how we're leading the industry with innovation, affordability, and experience.

Contact Us

Oasis accuracy
By Ginny Kenyon January 26, 2026
OASIS and ICD-10 coding influence decision-making, reimbursement, quality reporting, and agency performance. Ensuring accuracy is essential for every home health.
chronic disease education
By Ginny Kenyon January 22, 2026
Chronic diseases account for the majority of healthcare utilization and spending with a disproportionate share of hospital admissions, ER visits & long term costs
Interim Management
By Ginny Kenyon January 20, 2026
An experienced interim manager can provide stability, expertise, and momentum- if the right individual is selected during your time of need and transition.
OASIS success
By Ginny Kenyon January 17, 2026
OASIS plays a critical role in care planning, quality, reimbursement, and regulatory compliance and is also key to success and integrity of Medicare Home Health.
policy and procedure manuals
By Ginny Kenyon January 15, 2026
Policies and procedures serve as the foundation for consistent, fair, and effective operations. Your manual should be a living breathing guide for your agency.
chronic disease education
By Ginny Kenyon January 7, 2026
For aides, education in chronic diseases is not just helpful, it is essential for ensuring safety, dignity, and quality of life for the people they serve.
nurse key to HHCAHPS
December 23, 2025
Educate your staff to the HHCAHPS questions so they remember that performance is measured by the patients and will be reflected in the survey findings and payment
success in home health surveys
December 19, 2025
Surveys are heavily focused on data to serve as evidence of your agency's practices. Create a "Survey Book" containing all required documents for immediate access.
December 18, 2025
For home health agencies, a regulatory survey is not just an inspection—it's a high-stakes assessment of your commitment to patient safety, quality care, and operational compliance. Since repeat surveys are unannounced, the goal is to cultivate a culture of "survey readiness every day." Preparing your agency for a successful survey requires proactive planning, meticulous documentation, and full staff engagement. Below are the steps to build for continuous compliance. 1. Develop a Survey Team: Preparation starts with designating a core team responsible for the survey response. Clear roles ensure a calm, organized, and efficient process when a surveyor walks through the door. Each person needs to know exactly what they are responsible for and what metrics they need to track to be sure the agency is always ready for a survey. The Administrator/Survey Lead: Must be present for the entrance conference. This person is the main point of contact, handles high-level questions, and maintains a professional atmosphere for the organization with the agency staff and with any surveyors. Director of Clinical services/ Supervisor: This team member is responsible for assuring all documentation is reviewed and appropriate. This includes OASIS accuracy, that the plan of care matches the OASIS findings, and visit documentation follows the plan of care. ICD-10 Coders: This team member reviews the OASIS and matches it with the discharge summary to assure accuracy of OASIS (along with DCS or Supervisor). The coders also verify the ICD-10 code accurately reflects findings of the OASIS. Clerical Support: Staff is responsible to all personnel records monthly review for required documents and all new employees for same while reporting any missing documents (e.g. updated license, auto insurance, driver’s license etc.). Create plans and have operations in place to communicate at least a month in advance to employees when items need updated. This person is also responsible for managing the logistical needs when the surveyors are on site (e.g., Wi-Fi password, workspace, etc.) to create a buffer for management. They also discreetly communicate critical questions to the Survey Lead. The team member acting as Survey Lead is considered the survey readiness team leader. Promoting survey readiness should include regular monthly meetings with all of the survey readiness team members. Each team member should be ready to report on the status of their responsibilities and any data to support their findings. These findings include: a. Status of OASIS accuracy and any staff who need training. b. Planned OASIS training that provides regular updates on areas where staff continue to struggle. c. Plan of care with matching visit notes d. Personnel files and any updates when employees are not responding to the request for documents e. Status of continuing education per state or federal requirements f. Yearly evaluations with supervisory visits to support evaluation. Supervision needs to pay particular attention to hand washing according to policy and standard infection control procedure when getting in an out of bag, with client contact, or coming in and out of the home. This remains one of the primary findings by surveyors. g. Evidence of yearly required continuing education such as: • Infection control • Patient Rights and Advocacy to uphold dignity and autonomy • Emergency Preparedness with response protocols; evidence of bi-yearly practice drills for a potential emergency • Medication Management and safety to prevent errors • Updated relevant health care regulations and policies • Cultural competency to enhance communication and care for diverse populations. All data collected by the team members may need to be sent to the compliance manager and may become part of a plan of correction for the Quality Assurance program. Should you need assistance with survey readiness, please continue to part 2 of this series and call Kenyon Homecare Consulting at 206-721-5091 to help you get there!
ICD 10 coding and Oasis
November 25, 2025
In the regulated world of home health, OASIS and ICD-10-CM Coding integrity non-negotiable for quality, compliance, and critically, and agency's financial health!