July 24, 2012

The ICD-10 Encyclopedia – Finding Business Value in the Mandate

By Dennis Winkler

We all know that transitioning from the ICD-9 world to the ICD-10 world will increase complexity within our organizations. This increased complexity will become a major work driver as entities strive to achieve compliance. What we sometimes overlook in our preparatory efforts, however, are the inherent opportunities that the ICD-10 transition presents to help us find long-lasting value for the business. Blue Cross Blue Shield of Michigan found one such opportunity in our use of a data repository.

The problem

Early on in the ICD-10 transition preparations, we identified four essential business needs. First, we needed a way to define and begin using the 150,000-plus ICD-10 codes. Second, we needed a way to associate the ICD-9 and ICD-10 codes within our environment as a means of transitioning to their use. Third, we needed enterprise-wide access to this information. Fourth, we needed an environment in which the enterprise level data/information, including master data, could be updated and maintained easily.

The search

Knowing that these four needs could be met by using a master data management (MDM) tool that can help manage ICD codes, BCBSM set out to find a third-party MDM tool. This tool would house the ICD codes, their descriptions and the associations of the various codes to one another; provide enterprise-wide inquiry access to the information; and maintain the code data in a controlled and disciplined manner.

The solution

After an in-depth search involving consideration of several third-party products, BCBSM purchased the ICD-10 Appliance developed by HighPoint Solutions using Informatica MDM as the ICD code-based master data repository (which we coined the “encyclopedia”).  The “encyclopedia” addresses all the defined requirements as outlined…and then some.

Although the “encyclopedia” currently is restricted to current ICD codes, it is set up to handle any future ICD codes, both in terms of annual updates (end-dating existing codes and replacing them with others) as well as future structural code changes like ICD-11. The “encyclopedia” also has been expanded to store where the codes are used within the BCBSM environment. This gives us the ability to track where the codes that will assist us in the impact assessment during the annual update process are being used.

From a long-term perspective, the “encyclopedia” also easily can be expanded to incorporate other types of codes already supported by the ICD-10 framework, but which we’re not loading at this time (such as HCPCS and CPT codes). So even though we have built an enterprise-level ICD code system, we are positioned to expand its use and easily migrate it to be the BCBSM code management environment tool simply by adding the additional code types and associated data.

In short, the encyclopedia provides the basis for a master data management strategy for BCBSM that will provide value far beyond the ICD-10 compliance date.

About the Author

Dennis Winkler is the Technical Program Director of Program Management and ICD-10 for Blue Cross Blue Shield of Michigan and Blue Care Network of Michigan. He is responsible for ICD-10 program direction and is the IT business partner for Medicare Advantage. Dennis graduated with distinction from the University of Michigan's Ross School of Business. He spent his first 11 years of his career with Anderson Consulting (now Accenture); specializing in large, complex system development projects. Winkler joined BCBSM in 1998 and since has been responsible for leading major enterprise programs including HIPAA 4010 implementation, Social Security Number elimination and the National Provider Identifier initiative, among others. He has spoken at several national summits and seminars about ICD-10 since BCBSM began its ICD-10implementation.

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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.