Utilization of ICD-10...Thing to Consider
Now that the United States has transitioned from the
ICD-9-CM standard to the ICD-10 standard, what types of activities should an
HCO consider to attain best utilization of the new coding standard and
documentation, why?
Transitioning from the International Classification of
Disease Ninth edition (ICD-9) to the International Classifications of Disease
Tenth edition (ICD-10) was no walk in the park. From restructuring work
processes to upgrading billing systems, healthcare organizations (HCO’s) grappled
with the task of implementing the new coding system. The difference in coding
classification was going from 17,000 in ICD-9 codes to 155,000 in ICD-10 codes allowed
for a more comprehensive and detailed set of diagnosis and procedure codes
(Wager, Wickham Lee, & Glaser, 2013, p125). In order to accommodate the
changes HIPAA required entities to be compliant with the new guidelines
established by ASC X12 5010 by January 1, 2012. The change from HIPAA 4010 to
ASC X12 5010 was established to accommodate a more detailed system (Hoy, 2016).
Moreover, meaningful use requirements to track clinical conditions and improve
public health by a more comprehensive system of reporting could only be
accomplished by transitioning to ICD-10. Since ICD-10 is more detailed then
ICD-9, the data reported is more comprehensive and allows payers and HCO’s to
determine best practices when treating patients. In order for HCO’s to benefit
from this transition and attain best utilization focusing on training,
improving documentation, mapping and continuously analyzing data will be key.
Training is key in effectively utilizing the new coding
system. According to Zeisset and Bowman (2012), inadequate preparation reduces
the benefits of the new coding standards. Organizations should have established
a training process to reduce documentation errors to improve coding processes.
Simply relying on computer assisted coding systems (CACS), is insufficient and
coders must familiarize themselves with ICD-10 PCS (procure coding system), and
ICD-10 CM (clinical modification) in order to generate quality data (Zeisset
& Bowman 2012). Training also helps facilitate the processing of claims.
Inadequate coding issues will increase claims being denied. Training staff
personnel on the importance of adequate documentation will help mitigate risk
and reduce denials.
Analyzing processes and determining what strategies will be
used for mapping data is also very important. Organizations need to determine
if customized mapping will be used to create data sets or if codes will be
mapped using general equivalence mapping (GEM). Systemized Nomenclature of
Medicine- Clinical Terms (SNOMED-CT) is a comprehensive clinical terminology
that can be used to create custom mapping rules. Cartagena, Schaeffer, Rifai,
Doroshenko, and Goldberg (2015), argue that “GEM mapping is ideal for creating
related codes, but not for automated mapping”. Moreover, SNOMED-CT is being
used to capture comprehensive clinical data more frequently and returns a
higher percentage approximately seventy-six percent of ICD-10-CM codes
(Cartagena, Schaeffer, Rifai, Doroshenko, & Goldberg, 2015). Data can be
used to determine changes in reimbursement and improve quality of care.
Moreover, data collected can be analyzed to determine public health concerns.
HCO’s will benefit if they train their professionals on the
importance of accurate documentation. The majority of coding issues come from
poor documentation habits. Moreover, training coders and other clinical staff
on the changes that will take place is also key in effective implementation of
ICD-10. Analyzing and coming up with a strategy to map data sets used will also
be beneficial. With the new detailed coding system organization can monitor
best practices and analyze denials more effectively.
Reference:
Cartagena, P., Schaeffer, M., Rifai, D., Doroshenko, V.,
& Goldberg, H. (2015). Leveraging the nlm map from snomed ct to icd-10-cm
to facilitate adoption of icd-10-cm. Journal of the American Medical
Informatics Association, (3), 659-670; DOI: 10.1093/jamia/ocu042
Hoy, V. (2016). When
5010 intersects with icd-10: proceed with caution. Retrieved from: http://www.icd10monitor.com/5010/105-when-5010-intersects-with-icd-10-proceed-with-caution
Wager,K., Wickham Lee, F., & Glaser, J. (2013).
Healthcare information systems a practical approach for healthcare management
(3rd ed.) San Francisco, CA: Jossey-Bass
Zeisset, A., & Bowman, S. (2012). Strategies for icd-10
implementation. Healthcare Financial Management. Retrieved from: http://web.b.ebscohost.com.proxy.cc.uic.edu/ehost/pdfviewer/pdfviewer?sid=7afac424-3ad3-4b57-a19e-500f544b1914%40sessionmgr104&vid=0&hid=107
