September 19, 2016

ICD-10: Coding the Killers

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As it does every year, the Centers for Disease Control and Prevention (CDC) recently released its list of the leading causes of death in the United States. With the transition to ICD-10 and new codes facing provider organizations looming on Oct. 1, 2016, what should coders be aware of regarding this list? 

A Look at the List 

According to the CDC’s National Center for Health Statistics (NCHS) official report, these were the top 10 leading causes of death in the United States in 2015, along with the number of deaths for each:

  1. Heart disease: 614,348
  2. Cancer: 591,699
  3. Chronic lower respiratory diseases: 147,101
  4. Accidents (unintentional injuries): 136,053
  5. Stroke (cerebrovascular diseases): 133,103
  6. Alzheimer's disease: 93,541
  7. Diabetes: 76,488
  8. Influenza and pneumonia: 55,227
  9. Nephritis, nephrotic syndrome, and nephrosis: 48,146
  10. Intentional self-harm (suicide): 42,773 
For most organizations, this list is consistent with your top DRGs and high-volume cases. But knowing the specific ICD-10 changes for each is critical. 

Heart Disease and Bundles 

ICD-10 coding for heart disease is not too different than it was under ICD-9. As before, coders must stipulate acuity and type of heart failure (congestive heart failure, systolic versus diastolic, etc.). Specific documentation must be present to ensure correct coding, reimbursement, and quality reporting.

Coders should also be aware of CMS’s recent announcement for new Medicare payment models regarding heart disease and cardiac care. Proposed bundled payments for medical and surgical cardiac care were announced by the agency on July 25, 2016. Bundles are just one of many alternative payment models (APMs) already in use. 

According to CMS, heart attacks and strokes “cause one in three deaths and result in over $300 billion of healthcare costs each year.” The correct coding of heart disease, cardiac rehabilitation services, and cardiac procedures such as bypass surgeries is paramount for organizations seeking to move to cardiac bundles. 

Cause and Factors Important for Cancer Coding 

Cancer coding in ICD-10 is one of several areas in which more focus is being placed on cause and influencing factors, including geographical location. These specific ICD-10 codes, in addition to correct patient demographic data, will be used by the CDC and others to connect types of cancers and environmental causes in specific geographic areas. Coders will be elevated to the position of primary data gatherers for population health analytics, as ICD-10’s granularity helps steer stronger data analysis of factors affecting cancer patients.

Pneumonia and Respiratory Coding Gets Specific 

Some diagnoses and codes are hard to articulate, such as pneumonia. A tip for coders: make sure to look at the specifics of the diagnosis, as clear documentation is required. Go back to the tests and check all diagnostic reports, including radiology, lab results, etc. 

After Oct. 1, 2016, it is predicted that unspecified codes will go from being frowned upon to disallowed. Although ICD-10 includes some unspecified codes for respiratory conditions, payors will likely deny them in many instances. 

Assuming Relationships in Diabetes 

Diabetes guidelines also changed in ICD-10. Coders are now allowed to assume a causal relationship, whereas this relationship had to be specifically linked in ICD-9.

External Cause Codes Ahead

While external causes didn’t make the list of top killers, they do warrant a closer look by clinical coders. ICD-10 greatly expanded external cause codes. And there’s an important reason for this.

Determining what happened and where may not be necessary for reimbursement, but that data will be required as coders transition to the role of data gatherers for population health analytics. External cause code statistics can be used to pinpoint accident-prone areas and root causes. In some cases, these codes can be funny: “struck by a duck while water-skiing,” for example. But humorous or not, codes must correctly abstract cause so that data can be properly mined. 

Furthermore, the “when,” “what,” and “where” of each encounter must be specified through coded data to protect providers against medical malpractice claims and denials. If it was not documented at any point, the code will be unspecified. But as mentioned above, continued use of unspecified codes may have huge reimbursement repercussions. 

An expanded number of external cause codes means more information can be coded. Deeper data pertaining to disease diagnoses and causes is critical for improving population health. 

ICD-10’s Role in Population Health

As the industry continues to shift from quantity-based to quality-based healthcare, ICD-10 codes will take center stage, defining patient populations for preventative services and guiding service line expansions. Nowhere is this more evident than when coding for the top 10 killers as listed by the CDC.

While improving data to abstract for health statistics has been talked about for years, ICD-10 finally makes it possible. Granular coded data and its analysis will trigger new treatments and specific preventative measures. This is the data we’ve all been waiting for! 

So as the coding industry separates itself from solely dealing with reimbursement to engage in population health as well, data will help guide direction and remediate problems. And all the relevant information will come from coders. 

Goals should include continually increasing specificity and identifying targets for improvement.

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