ICD-10 Granularity: Why you need to take advantage of the data

Carl Natale
by Carl Natale

Besides providing punchlines to amateur comedians, it isn't unreasonable to wonder why there are so many ICD-10-CM/PCS codes.

Perficient, an  information technology consulting firm with clients throughout North America, attempted to explain why we have to use words such as "specificity" and "granularity" so much with its webinar "How to Leverage Increased Data Granularity in the ICD-10 Code Set."

Mike Berard, a senior solutions architect in the healthcare division of Perficient, talked about how healthcare organizations can use that new data found in ICD-10 codes. Although Berard works with payers and health plans, his presentation has implications for providers too.

According to the slides, Berard says healthcare reform will aim to reduce costs. And the ICD-10 data will help healthcare organizations do that by identifying inefficiencies and ways to improve patient care. "Having good data is the key to evaluating disease management, population needs, eliminating waste, forecasting budgets, providing care management and other business decisions that affect the bottom line."

This reminds me of a couple things that Gillian Price, who helped some hospitals through the ICD-10-CA transition in Canada, told me in a recent interview.

First, she said because Canada has a single-payer based healthcare system, the ICD-10-CA was designed primarily for clinical use. Not reimbursement like the ICD-10-CM/PCS coding the United States will use.

Second, she said the medical coders in Canada went from "librarians" who memorized and wrote down numbers to more analytical professionals who were part of the process.

So if we take those points into consideration when reading Berard's slides, there are three takeaways healthcare providers (I'm talking to everyone from small practices to large hospitals) need to monitor:

ICD-10-CM/PCS is built for capturing financial metrics

Not sure I totally agree with Price since the World Health Organization created the ICD-10 structure and our CMS filled in the details. But if it even appears to be true, then American healthcare might as well take advantage of that capability.

Medical coders have an opportunity to become analysts

Whether they can learn to interpret the data for financial or clinical analysis, medical coders are in a good place to explain to their physicians what the data means. It's either that or someone is going to hire consultants.

Payers are preparing to become more "efficient"

Note that Berard is working for payers and health plans. Those clients are looking for efficiencies and ways to save money. If providers don't take the same initiative, then they will have to rely on reimbursement neutrality to keep revenue stable.