By Susan Clark, HIT Solutions Executive, eHealthcare Consulting Inc.
Twitter: @ehealthcareorg
Are you feeling like ICD-10 and Meaningful Use are your ‘frenemies’, competing for your attention like Paris and Lindsay, Katie and Rhianna, or Taylor and Selena? Then it is time to re-examine that relationship because in reality ICD-10 has the back of Meaningful Use.
I am still not seeing it. Where do these two meet up?
Take, for example, the following Meaningful Use Measures, which are present in all three final or proposed stages, to understand how valuable a more precise code will be.
Patient Electronic Access
To empower patients, they need access to accurate and clear information. If a patient looks at an online problem list and it has a code with “Not Otherwise Specified” or “Not Elsewhere Classified”, they are not likely to know what that means. And whether chosen because it was the easiest to find at the top of the list, or because an accurate code simply does not exist in ICD-9, it does not paint an accurate picture of the patient’s overall health.
Clinical Decision Support
Clinical Decision Support is designed to trigger an alert, an intervention, patient education materials, etc. based on the appropriate diagnosis. Can you imagine the difference in type of alert that can be implemented if you use E11.22, type 2 diabetes mellitus with diabetic chronic kidney disease or E10.331 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema rather than the all-too-common non-specific code of 250.00 diabetes mellitus without mention of complication, Type II or unspecified type not stated as uncontrolled?
Quality Measures
Compared with ICD-9, ICD-10 allows for greater specificity in delineating a patient’s diagnosis, which will lead to improved tracking of patient outcomes. ICD-10 also accommodates newly developed diagnoses and procedures, and innovations in technology and treatment that are not supported in ICD-9. Information mined from the CQMs will provide an ability to track provider performance and suggest improvements for best practices.
Public Health
Even though the American public has already forgotten the Ebola scare of last summer, the disease has not been eradicated. Did you know that there is not a code in ICD-9 for this disease? It is currently often classified to 078.89, Other specified diseases due to viruses, but may also be classified to 065.8, Other specified arthropod-borne hemorrhagic fever. Makes it really easy to report and track, right? By comparison, ICD-10 says the Ebola virus is A98.4. No confusion. Now, imagine that all providers were transmitting syndromic surveillance messages on an ongoing basis to their respective states and on up to the CDC. How quickly could we spot an outbreak of this or many other diseases?
It is all too overwhelming. How do we prepare for ICD-10 AND Meaningful Use with so few resources?
As the saying goes, eat the elephant one bite at a time. Nobody is singularly responsible for all 68,000 codes, only those relevant to your scope of practice. Start by identifying the top 10-20 diagnoses for your practice or department. For each diagnoses, look at the following:
- Do your current templates incorporate prompts and fields to gather the information to get to the most specific ICD-10 code?
- What medications and tests are generally associated with this diagnosis? Make sure they are easily available in pick lists for the providers.
- Review clinical decision support rules associated with the diagnosis.
- Look at the patient education prompted and available. Is the association a manual process or automated by a vendor?
This should not be a hill conquered by an army of one. Include every level of staff who has reason to touch an encounter, from registration, through clinical, to ancillary (e.g. laboratory, pharmacy), to the coders and billers in order to find every affected component in the documentation lifecycle. After you conquer the top diagnoses and want to really get fancy you may also consider looking at your top denied codes for an opportunity to enhance documentation and clarity for clinicians prior to ICD-10 going live. Make sure all involved know this is an effort to improve patient safety and reimbursement, which tends to improve participation in a project. Clinical documentation improvement efforts will undoubtedly improve clinical, financial and administrative performance and should be a standing element of a continuous quality improvement program.
I am still not feeling the love. No matter the size of practice, this can still be a daunting project. There is a lot of variability in solutions between software, specialty, size, and geography. Communicate with your vendors regularly. Many have helpful webinars. You may also consider contracting with a professional project manager or subject matter expert as a constructive, experienced impartial perspective. Depending on level of engagement, contracting for assistance may not be as costly as one might think. Soon, you will no longer be frenemies with these regulations, instead fostering a blossoming relationship.
About the Author: HIT Solutions Executive at eHealthcare Consulting Inc. With a 20-year career that includes health information management, project management, ambulatory operations, quality improvement, managed care, and regulatory/accreditation compliance, Susan Clark, BS, RHIT, CHTS-IM, CHTS-PW seeks to create health information technology solutions to improve compliance, efficiency, data integrity, revenue, along with patient and staff satisfaction. She serves at a national level with the AHIMA House of Delegates and advocates for providers, practices, hospitals, and HIM/HIT professionals while keeping abreast of developing regulations and industry trends. This article was originally published on eHealthcare Consulting and is republished here with permission.