IT/IS Infrastructure and the Implementation of ICD-10
By Angela “Annie” Boynton RHIT, CPC, CCS, CPC-H, CCS-P, CPC-P, CPC-I
In efforts to remain productive, efficient and competitive, health plans, facilities and providers have begun to recognize the importance of information technology and information systems in the overall success of their respective fields. In other words, health care is becoming increasingly dependent on the advances, convenience and intelligence that computers can offer. That said, the implementation of ICD-10 will likely force health care based IT departments to make significant investments of resources and revenue into preparing systems, applications, databases, data warehouses, programs, reports and business intelligence systems to ensure compliance with the October 1, 2013 implementation deadline.
Perhaps the greatest impact will be felt by health plans, as so much of claim processing technology is automated and based on combinations of codes found within databases and data tables. While ICD-10 does offer new opportunities for the research and analysis of health care data, the impact of upgrading existing systems to support roughly 100,000 new codes and all associated possible code combinations cannot be denied. Simply overwriting all ICD-9 data will not be acceptable, as many organizations will continue to rely on ICD-9 information for pricing, payment, audit and historical claims information long after ICD-10 goes live.
Regardless of setting, health care IT departments must begin their implementation strategy by performing a complete analysis of all systems, reports, interfaces, algorithms and programs that are dependent on diagnostic and procedural code data. Because ICD-10 codes are physically longer, character length and the use of alpha-numeric fields must also be taken into consideration. Tracking all necessary changes in an “ICD-10 Change Log” can help IT departments meet compliance and avoid overlooking potential pitfalls.
To alleviate some of the burden of data mapping, CMS created the General Equivalence Mappings which can be found at the CMS Website: http://www.cms.hhs.gov/ICD10/02m_2009_ICD_10_CM.asp#TopOfPage.
The GEMs offer bi-directionality in that they can take an existing ICD-9 code and map it forward to its ICD-10 equivalent(s) or take an ICD-10 code and map it backward to its ICD-9 counterpart. Keep in mind that in many cases there may not be an existing code within the ICD-9 or ICD-10 code sets to map to. For example CMS has stated that: ICD-10-CM code Y71.3 – Surgical instruments, materials and cardiovascular devices (including sutures) associated with adverse incidents has no corresponding ICD-9-CM code to map back to. The same is true for ICD-9-CM Procedure code 89.8 Autopsy; there is no equivalent in ICD-10-PCS to map forward to.
Clearly the GEM files will offer value by assisting IT/IS departments with the arduous task of mapping data; it will still require significant resources to complete. And that doesn’t even take into account the testing, vendor, education, training and IT budgetary impact, which will also be significant. Successful juggling of these goals will be of utmost importance in order for organizations to continue to make well-informed business decisions.
It would be wise to anticipate that the migration to ICD-10 will have the greatest overall impact on IT/IS departments. Regardless of setting, wherever there exists IT/IS-based dependency on diagnostic or procedural coded data, compliance will have to be met. The key will be to approach ICD-10 implementation step by step, and the time to begin is now. A well-thought out and documented plan will ensure that business intelligence remains just that, intelligent.