September 30, 2014

The Collision of Two Worlds in an ICD-10 Universe

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Recently I had the privilege of attending the National Association of Healthcare Quality’s Annual Educational Conference in Nashville, Tenn. Not surprisingly, I found myself sitting in on the presentation titled “Making Sense of your Data After ACA and ICD-10.” As a health information management (HIM) professional working in multiple settings, including clinical documentation and ICD-10, I understand and am quite passionate about the overlap between data integrity and quality outcome reporting. I was very interested in what would be presented from “the other side of the fence,” which we refer to in the HIM world as “the quality world.” The session was presented well and was extremely informational; however, I walked away with a gnawing feeling of unrest that there still exists too much separation of these two worlds. 

The actions of a quality-minded professional are clinically focused and revolve around direct care to patients and patient outcomes. The HIM professional considers the most appropriate code to assign based on the clinical documentation in the record and the financial implications as they relate to timeliness of coding the record and billing. The two worlds collide when patient quality outcomes are reported utilizing the coded data assigned by HIM coding professionals. This collision is the driving force for both sides to work together to ensure that clinical data integrity exists. The integrity of the clinical data being reported is essential to supporting and improving quality of care for patients as well as the fiscal health of organizations providing that care. 

Several very valid questions were brought up in the presentation that I attended, including:

  • How could or would the quality professional know that the correct ICD-10 CM/PCS code had been assigned, considering the expectation of a steep learning curve related to transitioning to ICD-10?
  • Will there be a period of inaccuracy regarding data being reported during the ICD-10 transition that could disrupt trending patterns of quality initiatives and outcomes?
  • With the availability of more specific external cause codes, could quality of care be studied at even a more granular level, resulting in more focused prevention and educational quality initiatives and programs?

This simple overlap between quality and HIM is only one example of the far-reaching effects this ICD-10 coding transition will have on a healthcare organization. A proactive approach to ICD-10 can help ease concerns from both within the HIM world and outside the doors of the HIM department.  A robust ICD-10 CM/PCS educational component for coding professionals is a necessity. The knowledge that this education plan exists will help address the apprehension that other departments, such as quality, might be feeling. If administration is hesitant with moving forward to prepare for the ICD-10 transition, other departments outside of HIM need to express their support and explain the need for a seamless transition. 

The time is now, in today’s rapidly changing healthcare environment – with its strong shift towards pay-for-performance and quality initiatives – that all “worlds” within every healthcare organization work toward breaking down boundaries. The goal of providing the highest quality of care in the most cost-efficient manner in any type of healthcare setting should drive all other organizational efforts. The integrity of the clinical data being reported is essential to support this goal. Healthcare organizations must strive for a collaborative end-to-end process that incorporates technology, education, and support to ensure clinical documentation integrity starts at the point of care and follows through until final coding.

About the Author

Lisa Roat, RHIT, CCS, CCDS is manager of HIM Services for Nuance Healthcare.   She has more than 23 years of experience and expertise within the healthcare industry specializing in clinical documentation improvement, coding education, reimbursement methodologies and healthcare quality for hospitals.  She is an American Health Information Management (AHIMA)- Approved ICD-10 CM/PCS Trainer and Ambassador.  Lisa has worked extensively with the development of ICD-10 education and services for Nuance Healthcare.

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Lisa Roat, RHIT, CCS, CCDS

Lisa Roat, RHIT, CCS, CCDS is manager of HIM Services for Nuance Healthcare. She has more than 23 years of experience and expertise within the healthcare industry specializing in clinical documentation improvement, coding education, reimbursement methodologies and healthcare quality for hospitals. She is an American Health Information Management (AHIMA)- Approved ICD-10 CM/PCS Trainer and Ambassador. Lisa has worked extensively with the development of ICD-10 education and services for Nuance Healthcare.

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