How ICD-10 coding can affect patient care

Carl Natale
by Carl Natale

If you're in an argument with a physician about ICD-10 implementation, they're going to deny any benefits for patients. To them, ICD-10 is an administrative burden. It's not a treatment or medication that they can see improve a patient's health.

The line between an ICD-10 code and that improvement in patient care is difficult to see. That was the purpose of a Healthcare Information and Management Systems Society virtual confernce session last week. "ICD-10: Improving the Patient’s Care and Their Experience, Too" was led by Chris Stahlecker, acting director of the Administrative Simplification Group in the Office of E‐Health Standards and Services at Centers for Medicare and Medicaid Services (CMS).

Stahlecker uses the session to explain how ICD‐10 codes will provide better data to improve management of patient care and better describe new diseases. The increased detail also links provider performance and patient's condition by better measuring outcomes, she says.

The more specific data will allow:

  • "Better analysis of disease patterns"
  • "Improved public health tracking"
  • "Better detection of fraud and abuse"
  • "Detailed data on injuries, accidents"

Because most of the world is using ICD-10 code set, U.S. health officials can use the better data to compare public health trends with global pandemics. This will help guide public health policy.

This kind of macro view of healthcare is a tough sell to physicians and hospital administrators who have spend time and money on ICD-10 implementation. There are more immediate uses of the more specific data. Stahlecker outlines how ICD-10 data can improve quality in medical practices and hospitals:

  • "ICD‐10 data can be used to drive organizational change for quality improvement"
    • "Providers and payers can more easily identify patients in need of disease management"
    • "Organizations can develop more effective and tailored disease management programs"
    • "Existing technologies, systems, and processes can be evaluated and redesigned to enhance patient care"
  • "Agency for Healthcare Research and Quality (AHRQ) quality indicators can help to evaluate data"

The quality indicators are used to identify areas of concern which merit study. The data can be used to track changes. The AHRQ is forming workgroups that will develop the quality indicators based upon ICD-10 data.

Stahlecker also lists other initiatives that will need ICD-10 coding and data:

  • "Key component of meaningful use is electronic reporting of quality data to CMS to ensure accurate capture, calculation, and reporting of clinical quality measures (CQMs)"
  • "CQMs measure and track quality of health care services within our health care system"
  • "Standards and certification criteria for EHRs includes ICD‐10 as optional vocabulary, designates SNOMED for EHR problem list"

What it comes down to the ability to study more specific data about patients' condition and treatment. Public health officials and policy makers are poised to do that. But there's a disconnect between them and the physicians who are treating patients. It's hard for them to see improvements.This debate isn't going to be settled until they have new diagnostic tools and treatments that improve their patients' health.