November 18, 2013

ICD-10 and Research: The Optimistic Approach

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I have a confession: I’ve had a sour attitude about ICD-10 lately. I know I’m not the only one, but I’m usually the champion and cheerleader for the new coding set.

It seems like there’s a large amount of negativity surrounding the transition to ICD-10, and the loudest voices seem to be the ones questioning the real value of making the move. I’m sorry to say that this negativity has penetrated my usually optimistic bubble.

We’ve all heard what the benefits are in implementing a more sophisticated coding system. We’ve all been told that our current way of doing things is simply not sustainable, and yet there is still resistance to bringing our health information and data into the 21st century. However, there is a stream of positivity about ICD-10 that we can all tap into. It will help to invigorate us in the final stretch and inspire us to keep refining our policies and processes long after Oct. 1, 2014.

 

During the last several years, the focus of ICD-10 implementation efforts has been on what we need to do to simply implement – and rightfully so. There are many other projects and initiatives that require our attention and resources, and we continue to do our best to make sure we meet the compliance date. But we should pause and take a moment to reflect on who will be using ICD-10 codes and information downstream, and ask: How will ICD-10 impact them?

The clearest example I have involves research. Clinics, universities, and integrated health systems have their own research departments. They use clinical data, post-visit data, to study certain populations and conditions. And because most clinical data is accessed in a post-claim environment through data warehouses, much of the information they draw on is based on diagnosis codes. I have had the distinct pleasure of working with researchers on ICD-10, and from the get-go they were eager to learn and understand. And now, while others are bemoaning having to make the switch, they are excited about the brave new world of ICD-10. Is ICD-10 the answer to all their prayers? No. But it is promising due to the availability of more information within the codes themselves, which reduces the need for extensive chart review and may make identifying populations a bit easier.

Research is critical in the world of healthcare, and it is required to help make improvements in treatment protocols and outcomes. The data we use to track the prominence of diseases within a population helps identify risks to the overall population so that proactive measures can be taken to disrupt trends.

From communicable diseases like whooping cough to chronic conditions like diabetes, diagnostic data plays an integral role in our healthcare system. Diagnosis codes provide a simple and effective way to communicate what is happening within our communities and all over the world.

You might say that ICD-9 has served this purpose for 30 years, so why fix what isn’t broken? For the answer, I recommend reaching out to someone who uses these codes and talking to them about the information they use to learn about disease processes and how to mitigate their effects on people. They rely on healthcare data that is gathered within the worlds of providers and payers – which means that they are reliant on information passed from the point of care to the point of payment. This means that all the unspecified codes that are used so often can become the basis for the data from which a research department will pull. Of course, this isn’t a black and white issue, though; providers can continue to choose unspecified codes in ICD-10 just as easily as they can in ICD-9. ICD-10 implementation is not a cure-all for all our ills.

We have identified the ultimate key to successful ICD-10 implementation. It doesn’t come from a vendor product, a consulting firm, or training. It comes from a shift in perspective. We have the choice to continue to see ICD-10 as a burden, and implement it under duress – or we can see it as a necessary step in the evolution of healthcare information and commit to making the best decisions possible to help those downstream who rely on the data.

In short, we should commit to:

  • Improving our coding by selecting the most accurate code possible, not just the ones we know by memory;
  • Support all patients past, present, and future by ensuring that diagnostic information is treated as an integral part of our health “story” and not just a means by which we get paid;
  • Foster awareness of all users of diagnostic codes and information by supporting them in their efforts to understand our health challenges and to explore ways to improve our well-being.

It is a small step that, again, only requires a shift in perspective. Sometimes, it just takes a reminder that we’re all in this together – and there really is something good that will come of it.

About the Author

Mandy Willis is a Certified Coding Specialist and AHIMA Approved ICD-10 Trainer with 15 years of experience in the healthcare industry. She has worked in the small physician practice environment, commercial payer and Medicare and Medicaid. Currently, her focus is on assisting all sectors of the healthcare industry in making the transition to ICD-10.

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Mandy Willis, CCS, CPEHR

Mandy Willis is a Certified Coding Specialist and AHIMA Approved ICD-10 Trainer with 15 years of experience in the healthcare industry. She has worked in the small physician practice environment, commercial and public payers. She is also co-chair of the Workgroup for Electronic Data Interchange (WEDI) ICD-10 Coding and Translation Subworkgroup. Currently, her focus is on assisting all sectors of the healthcare industry in making the transition to ICD-10.