Eeny, Meeny Miney Moe...Catch a Kitten, or a Code, by its Toe
By Girija Yegnanarayanani, PhD, director of applied CLU research at Nuance Communications.
"Eeny, meeny, miney, moe/Catch a tiger by the toe..." It's a familiar nursery rhyme, recited by children looking for a way to select who will be "it" for a game. The main principle of this ditty is choosing one (eeny) over another (moe). This is not unlike what can occur in the classification assignment when transitioning to ICD-10 from ICD-9. Important details can be lost in translation.
Take, for example, the dangerous encounter described above: catching a tiger by its toe. If we were to select the details using ICD-9 to document this today, we would accurately note that we caught an orange and black-striped, furry mammal, with four legs, a long tail, and whiskers - by the toe. However, that same basic description could allow someone to interpret the dangerous tiger as just a small kitten. It doesn't convey the same sense of severity or urgency.
Is it a Roar, or a Purr?
The granularity required for the ICD-10 transition has caused a lot of anxiety for providers and health organizations alike. But the lack of specificity available in ICD-9 codes (in relation to that provided by ICD-10) can lead to diagnosis confusion or the misidentification of important patient information.
According to a recent study published in Pediatrics, 26% of ICD-9 codes are convoluted when mapped to ICD-10, which can have a substantial negative impact on pediatricians' bottom line. It is this level of detail required in ICD-10 that makes general equivalence mappings (GEMS) an unreliable way to prepare fully for the transition. While GEMS does allow coders to see how most general ICD-9 codes will translate to ICD-10, this practice does not account for the level of specificity required under ICD-10, which will require that clinicians record additional identifiers to more fully describe care being provided. The new level of detail captured in the documentation will help to improve quality patient care and enable providers to better manage the health needs of their specific patient populations - and can clarify whether the furry, original animal purrs or roars.
How is technology impacted?
Natural Language Processing (NLP) engines that can understand clinical narrative as well as the right level of details using ICD-10 specificity can be leveraged to meet coding and quality measures accurately. However, if health IT can only recognize and manage those details recorded by clinicians using an ICD-9 lens and discards additional information, the picture changes dramatically from a savage beast to a house pet. Using intelligent systems and tools that accommodate specificity and "learn" which details are needed to ensure that the appropriate information is captured can help ease the burden being placed on the care teams documenting their patients' conditions. It can also help the coders and clinical documentation specialists who are working to ensure a patient's story is complete, accurate, and compliant.
The level of specificity isn't just for physicians and coders. These details also require that technology keep pace with the level of sophistication required under new coding standards. Although we've been able to hit the reset button on the ICD-10 countdown, it's important to continue to keep the momentum going. Strategies that take into account the increased levels of clinical documentation specificity will ensure healthcare organizations are paid for the high quality care they are providing to their patients and to their community. The danger of not doing so places organizations at risk for RAC denials, and in the dangerous position of misrepresenting a tiger as a kitten.