Data Carries Great Importance for the ICD-11 Transition

Original story posted on: December 2, 2019

It is important to understand the data needs for your organization from a content perspective as you prepare for ICD-11.

As we talk about preparing for the transition from ICD-10 to ICD-11, it is important to realize the importance of data. Healthcare data is important today for population health, determining risk adjustment factors for Hierarchical Condition Categories (HCCs), establishing relative weights for Diagnosis-Related Groups (DRGs), and for quality reporting. The transition of data from ICD-10 to ICD-11 will be needed, as it was for the ICD-9-to-ICD-10 transition.

To prepare for this transition, I think that it is important to understand the data needs for your organization from a content perspective. In other words, understand the diagnosis and procedure codes that you are assigning today, and why you are collecting them. All assigned codes should have a reason:

  • Reimbursement (e.g. MS-DRGs, APR-DRGs, APCs, HCCs, etc.)
  • Quality Reporting (e.g. Value-Based Purchasing)
  • Statistical (another department may use for reporting)
  • Population Health (e.g. Social Determinants of Health)

If you don’t have a reason for collecting data, then discontinue it, as data collection takes time and impacts efficiency. Collecting data “because we have always collected” the data is not a good reason for taking the time. 

Each organization should document its facility-specific coding guidelines to assist in understanding their data needs. The health information management (HIM) department should discuss data needs with marketing, quality, information services/systems, administration, and revenue cycle to determine the depth and breadth of the data needs for the organization. It is important to document the state’s data commission in the guidelines, and how the facility will interact with the state data commission.  

If you document the guidelines for ICD-10, the transition and research for ICD-11 will be easier. If you understand the various areas in your organization that is using coded data, you will be aware of which departments will be impacted by the ICD-11 transition.

The facility-specific coding guidelines can be documented today, in preparation for the ICD-11 transition. Watch for your Journal of the American Health Information Management Association (JAHIMA) edition that contains a practice brief for writing your facility-specific coding guidelines. The practice brief covers various topics that should be addressed in the facility-specific coding guidelines, such as procedural and content matters.

Procedural considerations include who responds to denials, how to escalate physician query non-response and escalation of disputes between the coding professional and qualified staff.

Content considerations include the coding of various areas such as family history, personal history, status codes, allergies, smoking status, procedures that are assigned by HIM coding professionals, etc.

The electronic version of the practice brief also contains a spreadsheet that lists the various areas of consideration when writing facility-specific coding guidelines, as well as an example of how one facility used the spreadsheet to develop their facility coding guidelines.

Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.

Related Stories

  • The 10-Year Coder Challenge: Growing Your Skills beyond CCs and MCCs
    Today’s coder must embrace APR-DRGs and HCCs in order to stay relevant. At the beginning of the year, Facebook’s “10-year challenge” hit the web, with users posting comparison profile pictures from 2009 alongside their 2019 selfies. I’ve since seen a…
  • Implementation: ICD-10 Lessons Learned
    EDITOR’S NOTE: George Vancore appeared during a recent edition of Talk Ten Tuesdays focused his report on lessons learned during the implementation of ICD-10 in preparation for ICD-11. This article is a summary of his remarks. When Chuck Buck recently…
  • HCC Coding: Preparing for ICD-11
    HCCs thrive on specificity and ICD-11 will provide a higher level of specificity than in ICD-10. For those of you who are coding for hierarchical condition category (HCC) purposes, you know that HCCs are categories of related ICD-10 codes. Only…