The Health Care Manager Volume 34, Number 2, pp. 123–127 Copyright # 2015 Wolters Kluwer Health, Inc. All rights reserved.
International Classification of Diseases, 10th Revision, Coding for Prematurity Need for Standardized Nomenclature Shilpi Chabra, MD The International Classification of Diseases, Ninth Revision, Clinical Modification was introduced in the United States in 1979 as a coding system to document inpatient diagnostic and procedural codes. However, transition to International Classification of Diseases, 10th Revision (ICD-10) has been federally mandated by October 2015 due to advances in medical technology and procedures in medicine. This includes ICD-10, Clinical Modification and ICD-10, Procedure Coding System. The ICD-10 coding set is more detailed and specific and will add 54 000 diagnosis codes and 83 000 procedure codes to the International Classification of Diseases, Ninth Revision, Clinical Modification code set, thereby accounting for increased granularity of codes needed for evidence-based medicine. This article describes the importance of need for specificity of the codes and emphasizes the role of training in preparing for implementation of the ICD-10 coding system. An example is made for the need for accuracy in ICD-10 codes for prematurity as regards defining the premature population using standardized nomenclature. Key words: gestational age, ICD-10, prematurity
HE WORLD HEALTH Organization developed International Classification of Diseases, Ninth Revision (ICD-9), in 1975 (revised, 1976) which has been used by countries internationally to track different disease classifications.1 In 1979, the United States modified the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9-CM) system with increased diagnostic codes and incorporated inpatient procedure codes.2-4 However, with increasing information needs of our health care organizations, including electronic medical records, bioinformatics, and other technological improvements, the
T
Author Affiliation: Division Neonatology, Department of Pediatrics, University of Washington and Seattle Children’s Hospital Seattle, Washington. The author has no conflict of interest. Correspondence: Shilpi Chabra, MD, Division Neonatology, Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle, Washington ([email protected]). DOI: 10.1097/HCM.0000000000000053
ICD-9-CM could not meet the needs, and the Centers for Medicare & Medicaid Services decided to move the US health care system to the International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS).2,5,6 The transition from ICD-97 to ICD-108 system, which was initially scheduled for October 2013, has been delayed in the United States until October 2015. Planning for implementation of ICD-10 training has been ongoing at the health care facilities, and the most significant component of the transition has been considered to be the need for extensive training for implementation of ICD-10-CM/PCS among hospitals. This change will reflect the largest health care change in the past 30 years since the conversion to diagnosis-related groups.9 This transition will impact hospitals and health care facilities with regard to utilization review processes including coding and billing. This will also impact providers who will need to document patients’ medical conditions and also health care outcomes more effectively using specific language.10-12 123
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
124
THE HEALTH CARE MANAGER/APRIL–JUNE 2015
The ICD-10 coding system will help capture the highest level of specificity13 in diagnosis and procedural coding and requires training of providers who need to use appropriate key elements in the medical records for clinical documentation in order to categorize diseases and effectively reflect severity of illness. This also requires training of coders to ensure accuracy of coding specific to the clinical disease and acuity of patients. The implementation of ICD-10 system involves a massive expansion and change to a universal coding system that offers codes that are highly specific to the diagnoses and procedures performed by health care providers.9 Because of effective representation of diseases and procedures with ICD-10-CM/ICD-10-PCS, it will decrease medical errors, improve patient outcomes, and enhance health data reporting.2,14 Coding for each diagnosis and procedure is obtained from provider documentation in the patient chart. Appropriate documentation is therefore key for quality of care and compensation for the resources utilized. Accuracy of coding is also important in order to study trends in incidence of disease and prevalence of medical conditions. In order to allow global comparisons within countries, ICD-10-CM should use uniform nomenclature to ensure accuracy of the codes as these are used in large national databases to study trends in incidence of clinical conditions. It is of paramount importance for the classification of all diseases including prematurity to be standardized to allow for comparisons within countries around the world. BRIDGING THE CLINICAL AND ADMINISTRATIVE GAP Table 1 shows the ICD-9 codes and the converted ICD-10 codes for premature infants. The ICD-10 codes are specific to each week of gestational age (GA), and each code has a detailed description along with a numerical representation to clarify each completed week of gestation. However, there seems to be a discrepancy in medical terminology between what is published in ICD-10 and what clinicians commonly use based on national and international
guidelines especially because of the confusion around the concept of ‘‘completed weeks of gestation’’ for definition of preterm birth. This can cause inconsistencies among coders and providers, making it difficult to evaluate outcomes. DEFINITION OF PREMATURITY ‘‘Preterm birth’’ is defined as birth that occurs before the end of the last day of the 37th week (259th day) after the onset of the mother’s last menstrual period.15 The definition of prematurity by the World Health Organization is childbirth occurring at less than 37 completed weeks or 259 days of gestation.16 Traditionally, 37 completed weeks of gestation are numerically written as 37 0/7 or 37 (+0) weeks.17 In fact, 37 weeks’ GA is completed at midnight of 36 6/7 (ie, the last day of the 37th week is numerically represented as 36 [+6] or 36 6/7).18 However, this is not according to ICD-10, wherein 36 0/7 to 36 6/7 represents 36 completed weeks (ICD-10 code P07.39 represents GA 36 completed weeks of GA and is depicted numerically as 36 0/7-36 6/7). Preterm birth is defined as birth before 37 completed weeks of gestation (ie,
International Classification of Diseases, 10th Revision, Coding for Prematurity Need for Standardized Nomenclature Shilpi Chabra, MD The International Classification of Diseases, Ninth Revision, Clinical Modification was introduced in the United States in 1979 as a coding system to document inpatient diagnostic and procedural codes. However, transition to International Classification of Diseases, 10th Revision (ICD-10) has been federally mandated by October 2015 due to advances in medical technology and procedures in medicine. This includes ICD-10, Clinical Modification and ICD-10, Procedure Coding System. The ICD-10 coding set is more detailed and specific and will add 54 000 diagnosis codes and 83 000 procedure codes to the International Classification of Diseases, Ninth Revision, Clinical Modification code set, thereby accounting for increased granularity of codes needed for evidence-based medicine. This article describes the importance of need for specificity of the codes and emphasizes the role of training in preparing for implementation of the ICD-10 coding system. An example is made for the need for accuracy in ICD-10 codes for prematurity as regards defining the premature population using standardized nomenclature. Key words: gestational age, ICD-10, prematurity
HE WORLD HEALTH Organization developed International Classification of Diseases, Ninth Revision (ICD-9), in 1975 (revised, 1976) which has been used by countries internationally to track different disease classifications.1 In 1979, the United States modified the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9-CM) system with increased diagnostic codes and incorporated inpatient procedure codes.2-4 However, with increasing information needs of our health care organizations, including electronic medical records, bioinformatics, and other technological improvements, the
T
Author Affiliation: Division Neonatology, Department of Pediatrics, University of Washington and Seattle Children’s Hospital Seattle, Washington. The author has no conflict of interest. Correspondence: Shilpi Chabra, MD, Division Neonatology, Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle, Washington ([email protected]). DOI: 10.1097/HCM.0000000000000053
ICD-9-CM could not meet the needs, and the Centers for Medicare & Medicaid Services decided to move the US health care system to the International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS).2,5,6 The transition from ICD-97 to ICD-108 system, which was initially scheduled for October 2013, has been delayed in the United States until October 2015. Planning for implementation of ICD-10 training has been ongoing at the health care facilities, and the most significant component of the transition has been considered to be the need for extensive training for implementation of ICD-10-CM/PCS among hospitals. This change will reflect the largest health care change in the past 30 years since the conversion to diagnosis-related groups.9 This transition will impact hospitals and health care facilities with regard to utilization review processes including coding and billing. This will also impact providers who will need to document patients’ medical conditions and also health care outcomes more effectively using specific language.10-12 123
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
124
THE HEALTH CARE MANAGER/APRIL–JUNE 2015
The ICD-10 coding system will help capture the highest level of specificity13 in diagnosis and procedural coding and requires training of providers who need to use appropriate key elements in the medical records for clinical documentation in order to categorize diseases and effectively reflect severity of illness. This also requires training of coders to ensure accuracy of coding specific to the clinical disease and acuity of patients. The implementation of ICD-10 system involves a massive expansion and change to a universal coding system that offers codes that are highly specific to the diagnoses and procedures performed by health care providers.9 Because of effective representation of diseases and procedures with ICD-10-CM/ICD-10-PCS, it will decrease medical errors, improve patient outcomes, and enhance health data reporting.2,14 Coding for each diagnosis and procedure is obtained from provider documentation in the patient chart. Appropriate documentation is therefore key for quality of care and compensation for the resources utilized. Accuracy of coding is also important in order to study trends in incidence of disease and prevalence of medical conditions. In order to allow global comparisons within countries, ICD-10-CM should use uniform nomenclature to ensure accuracy of the codes as these are used in large national databases to study trends in incidence of clinical conditions. It is of paramount importance for the classification of all diseases including prematurity to be standardized to allow for comparisons within countries around the world. BRIDGING THE CLINICAL AND ADMINISTRATIVE GAP Table 1 shows the ICD-9 codes and the converted ICD-10 codes for premature infants. The ICD-10 codes are specific to each week of gestational age (GA), and each code has a detailed description along with a numerical representation to clarify each completed week of gestation. However, there seems to be a discrepancy in medical terminology between what is published in ICD-10 and what clinicians commonly use based on national and international
guidelines especially because of the confusion around the concept of ‘‘completed weeks of gestation’’ for definition of preterm birth. This can cause inconsistencies among coders and providers, making it difficult to evaluate outcomes. DEFINITION OF PREMATURITY ‘‘Preterm birth’’ is defined as birth that occurs before the end of the last day of the 37th week (259th day) after the onset of the mother’s last menstrual period.15 The definition of prematurity by the World Health Organization is childbirth occurring at less than 37 completed weeks or 259 days of gestation.16 Traditionally, 37 completed weeks of gestation are numerically written as 37 0/7 or 37 (+0) weeks.17 In fact, 37 weeks’ GA is completed at midnight of 36 6/7 (ie, the last day of the 37th week is numerically represented as 36 [+6] or 36 6/7).18 However, this is not according to ICD-10, wherein 36 0/7 to 36 6/7 represents 36 completed weeks (ICD-10 code P07.39 represents GA 36 completed weeks of GA and is depicted numerically as 36 0/7-36 6/7). Preterm birth is defined as birth before 37 completed weeks of gestation (ie,
