ICD-10, Meaningful Use and AHIMA – How do they all fit together?
The 83rd annual convention of AHIMA is getting underway as I write this, and with it HIM is at the center of the biggest regulatory reforms in most of our careers, ARRA/MU and ICD-10. At this event, new and evolving approaches to coder’s workflow in the MU era, provenance standards, documentation methodologies incorporating natural language processing (NLP), Computer-Assisted-Coding (CAC), Quality Reporting, and related services like Clinical Documentation Improvement (CDI) will be discussed. In many ways, it all gets down to billing and clinical codes. So I thought this would be a good time to take a look at the challenges and issues.
Quality healthcare through quality information?
Physician, policy advocate and certified coder, Dr. Mike Stearns was recently describing the distinction between billing codes and clinical codes. Billing codes are intended to get you into the neighborhood of the specific condition, explains Stearns. The clinical codes are needed for care, quality reporting, identifying appropriate order sets, and creating adequate clarity for medication management and reconciliation.
It will come as no surprise to readers of Healthcare Informatics or this blog that billing codes and clinical codes are fundamentally different. But the temptation to use them interchangeably can be overwhelming. When they don’t overlap, which is often, problems arise. No group of people understands this challenge better than the Health Information Management professionals who have been managing our medical records.
When clinicians select codes
When a patient presents to a clinician in a care delivery organization, there ends up being a clinician who declares the clinical diagnostic, as well as billing codes to describe that encounter. That declaration process in the age of EHRs and Meaningful Use is not simple. In addition to impacting reimbursement from payers as it always has, even in the paper world, the declaration has a broader impact. Specifically, quality measures and workflow are directly impacted; the former is required for MU attestation, the latter for clinical adoption.
The relationship of accuracy on Meaningful Use and Adoption
From an accuracy and simply a data perspective, the clinical codes now need to populate an Up-to-Date Problem List (required by MU in Stage One). From a broader MU perspective, these codes also take part in MU quality reporting. Hopefully, it’s obvious that clinical accuracy is far more important than billing accuracy for patient safety. That said, it can be expedient, albeit risky, to use billing codes, even when they are clinically not accurate. And making it easy, fast, and straight-forward for clinicians to even enter or pick an accurate clinical code is often hard or impossible.
Here’s where HIM innovations to be discussed at AHIMA get interesting. There has been increasing interest in using the clinician’s free-text narrative as the primary source of capturing the accurate clinical code, as well as the defensibly accurate and neighborhood-to-driveway accurate billing code. This often involves a combination of voice-recognition, NLP, CAC, and related services CDI, support and real-time compliance adjudication.
With any innovation, there are ultimately three sequential questions that need to be addressed. First, does the innovation actually work? For coding, the measure is coding accuracy. Second, is the innovation fast enough? In healthcare terms, what are the effects on the productivity of coders, abstracters, doctors, nurses, and health data specialists serving internal and external reporting needs? Third, is it polished and pretty enough? Obviously, if the first two questions aren’t properly addressed, polish is irrelevant. However, when we roll out technologies that work and are fast enough, but aren’t sufficiently polished, we often aren’t afforded the opportunity to go back and polish. Think about the consequences and please share your thoughts with me.
Are you coming to AHIMA?
This is my first visit to an AHIMA national convention and hope to meet many of you during the event. I’m excited that we live in an era where ICD-10 and MU mandates, combined with technology improvements and sensitivity to clinical adoption issues are explicitly coming together as professional opportunities for us all. I’ll report back on the high points of AHIMA when I return.
Joe Bormel, M.D., MPH
CMO & VP, QuadraMed
Developments in medical technology
have long been confined
to procedural or pharmaceutical advances,
while neglecting a most basic and essential component of medicine:
patient information management.
- John Doolittle