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Learn about upcoming investor events, press, and stock information. The transition to ICD in saw the number of available procedure codes increase from roughly 3, to more than 70, This change gives clinicians the ability to code procedures to a much higher degree of specificity and provides health systems the ability to unlock powerful clinical insights into how inpatient procedural care is delivered.
This article covers the benefits and drawback of ICD PCS, as well as concrete ways health systems can use these procedure codes to provide new clinical insights. The article also walks through the anatomy of the seven-digit alphanumeric codes and provides specific clinical examples of how healthcare organizations can slice and dice this data. When the U. This drastic increase means clinicians can code procedures with a much higher degree of specificity.
Although the shift to ICD required healthcare organizations to change how medical encounters are documented, doing so gives organizations the ability to harness powerful analytics behind ICD procedure codes. Armed with new insights into how inpatient procedural care is delivered, health systems can improve patient outcomes and value. Health Catalyst uses a Clinical Integration Hierarchy, which allows for more precise analysis of the care provided—and thus more actionable data for clinicians or administrators to review.
The Clinical Integration Hierarchy heavily utilizes ICD diagnosis codes to organize and analyze data according to care processes. This hierarchy groups healthcare into work processes that reflect how care is actually delivered, across departments and care settings, and provides a relevant, focused structure for prioritizing and implementing improvement initiatives.
By organizing and analyzing data according to care processes, health systems can determine which of these processes offer the greatest opportunity for improving quality and reducing unnecessary cost. Similarly, Health Catalyst is now building a Procedural Integration Hierarchy utilizing procedure-based code.
This allows healthcare organizations the ability to glean important analytics insights using procedure data as well as leveraging the higher degree of specificity that ICD allows. The addition of a procedural integration hierarchy will complement the clinical integration hierarchy and allow clinicians and hospital leaders more contextual information.
For instance, health systems are currently unable to identify by diagnosis codes if transplant patients had the transplant on their current encounter, or if the admission was related to underlying management of their medical condition.
Similarly, when looking at procedure codes, three different patients may have had a portion of their colon removed for varying reasons e. All three patients would show as having colectomies but the length of LOS, processes, and outcomes could be intentionally different.
Neither coding tool provides a full picture, as it captures single variables when classifying a patient stay; the procedural hierarchy will help add content and context to the data available. Even though the transition to ICD in disrupted the healthcare industry, the potential analytic benefits likely outweighed the disruption:.
The structure of the ICD PCS system is designed in a way that has the potential to drive powerful analytic insights. Each character can be one of any 34 possible values numbers , and letters A-Z, excluding letters O and I to avoid confusion with numbers zero and one. Additionally, characters have a hierarchical relationship and the same character placed in a different position has a different meaning Figure 1.
Going hand in hand with specificity, ICD procedure codes precisely define procedures with detail regarding body part, approach, medical devices used, and other qualifying information.
The addition of laterality, such as right-knee replacement vs. Additionally, the definition of each character is a function of its physical position in the code.
For example, the fifth character of the procedure code refers to the approach type, so a hospital administrator could look at the total volume of open procedures or the total volume of minimally invasive surgeries using just the fifth character.
Adding the seventh character, an administrator could look at the total number of biopsies performed across the system on a specific body part, for example. These examples help highlight the powerful level of specificity available for analysis using procedure codes. ICD-9 procedure codes contained only three to five numeric characters, limiting space for adding new codes.
ICD PCS was designed to have the flexibility for adding new codes as new procedures are added or new technologies come into play. ICD PCS provides precise and stable definitions of all procedures performed where ICD-9 procedure codes were based on outdated technology and lacked current, accepted definitions. The standardization of procedure codes brought stability and eliminated outdated terminology but did result in the limitations noted above.
As a result of increased specificity, with some complex procedures or multiple step surgeries, it can be difficult to determine what procedure was performed by looking just at the primary procedure code. In many cases, it may be necessary to look at secondary procedure codes in relationship to the entire procedure in order to correctly identify the type of surgery that was performed.
A good example of this is with a total knee replacement. A total knee revision is often coded the same as the initial replacement, with the addition of a secondary procedure code. For example:. With ICD, there can be multiple procedure codes to document and analyze. In the case of the knee replacement above, if someone looked at only the primary procedure code, he could easily misclassify the procedure.
Between the two procedures—total knee replacement and total knee revision—there would be intended variation between the two procedures such as time metrics in the operating room, difference in length of stays, readmission rates, or even cost case events. All of this intended variation would be inaccurately shown as unintended variation if only looking at the primary procedure code.
Currently, the U. This severely limits direct comparison of U. When the U. It also provides better data for measuring and tracking health care utilization and the quality of patient care.
National Center for Health Statistics. Section Navigation. Facebook Twitter LinkedIn Syndicate. What is it? A primary user of ICD codes includes health care personnel, such as physicians and nurses, as well as medical coders, who assign ICDCM codes to verbatim or abstracted diagnosis or procedure information, and thus are originators of the ICD codes.
ICDCM codes are used for a variety of purposes, including statistics and for billing and claims reimbursement. Public health is largely a secondary user of coded data. Why change? Some noteworthy benefits include: Easier comparison of mortality and morbidity data Currently, the U. The greater level of detail in the new code sets includes laterality, severity, and complexity of disease conditions, which will enable more precise identification and tracking of specific conditions.
Terminology and disease classification are now consistent with new technology and current clinical practice. Injuries, poisonings and external causes are much more detailed in ICDCM, including the severity of injuries, and how and where injuries happened.
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