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Introduction Emergency Departments (EDs) in Ireland often lack consistent, coded diagnostic data, limiting their ability to understand case mix, secure appropriate funding, and plan services strategically. ICD-10-AM coding at the point of diagnosis offers a solution but is rarely embedded in ED workflows. This project aimed to implement real-time ICD-10-AM coding using a custom-built diagnosis lookup system supported by education and staffing.Methods A bespoke IT tool was developed incorporating over 1,400 common ED diagnoses mapped to ICD-10-AM codes. Two dedicated medical students were assigned to deliver on-the-floor training, support clinicians with system use, and troubleshoot issues in real time. A series of four audits was conducted over a 6-week period to monitor compliance and identify barriers. Findings were fed back into iterative education and workflow adjustments.Results Initial compliance with diagnostic coding was 38%. Within three weeks of implementation, this rose to 98%. Audits highlighted common issues: low engagement from locum staff, failure to capture diagnoses in patients referred to inpatient teams and inclusion of self-discharged patients. These were addressed through targeted interventions. A final audit following full implementation demonstrated sustained high compliance (X%, pending final data). Diagnostic coding data is now being used locally to inform service planning and resource requests.Conclusion A multifaceted implementation strategy — combining a custom IT tool, dedicated support staff, and targeted education — resulted in a rapid and sustained improvement in ICD-10-AM coding compliance in an Irish ED. This enhanced diagnostic visibility strengthens local service planning and provides a reproducible model for national scale-up. *presenting author