Informatics: International Classification of Diseases-10: Implications for Nursing

Abstract

One of the biggest events to hit healthcare data in decades is the conversion of coded clinical data to the International Statistical Classification of Diseases and Related Health Problems: Tenth Revision, commonly referred to as ICD-10. The last change of this nature was in 1983 when Medicare implemented ICD-9 as part of the Inpatient Prospective Payment System (IPPS). Since that time, healthcare has advanced significantly and ICD-9 codes no longer represent the advances and complexities in care provided to patients; thus healthcare in the United States is expected to transition to ICD-10 on October 1, 2015.ICD-10 is intended to support the systematic recording, analysis, interpretation, and comparison of morbidity and mortality data from around the world (World Health Organization, 2011). There are two parts to ICD-10: ICD-10Clinical Modification (CM) and ICD-10- Procedure Coding System (PCS). Compared to ICD-9-CM with 14,000 codes, ICD-10-CM has 69,000 available codes to be used for diagnosis codes on all inpatient and outpatient accounts. In ICD-9-PCS there are approximately 3,000 codes; this will change with ICD-10-PCS to 72,000 available codes to be used only for inpatient procedural coding.ICD-10 will touch everything from registration and scheduling, to revenue cycle and payer contracts, information systems, and ultimately will be used to improve patient care and outcomes. The important and widespread uses of ICD-10 data make it critical to understand these new documentation requirements. As healthcare prepares for ICD-10 and the coding of data using an electronic platform, it is important to ask, What are the implications for nursing? Although the answer to this question is not easily found, this informatics column will shed light on the issue by providing a sample case and highlighting the role of nurse informaticists in this historical change in healthcare data. We will conclude that nursing's role in data collection and entry is important in the building of the ICD-10 database, and that the benefits to be achieved from this monumental effort are dependent on accurate documentation and coding.Sample Case: Pressure UlcerPressure ulcer was chosen as a sample case to examine in this column due to the costs incurred in treating pressure ulcers. It was also chosen based on the historical precedent whereby staging of pressure ulcers has been coded in ICD-9-CM from nursing charting/documentation (.Cfin.ters..fQr-MlfidLcare-&jyiadicai,d..S.er.v:ic.es.l[CMS3-& .N,ati.Q.n.aL.Cen.ter for Health ..Statistics LN.CHS.].,. 2.Q.Q.S).MethodThe following steps were used to identify nursing documentation needs for pressure ulcers related to ICD-10.1. Define pressure ulcers.2. Download the ICD-10-CM codes and identify all diagnoses related to pressure ulcers.3. Identify the data elements, i.e., the words used, in the pressure ulcer diagnoses in ICD-10-CM codes.4. Identify related data elements in the current electronic health record (EHR) nursing documentation on pressure ulcers.5. Perform a gap analysis between current EHR documentation by nurses on pressure ulcers and what is needed for nursing documentation in ICD-10-CM.6. Reconcile findings with other databases using nursing documentation on pressure ulcers in short-stay hospitals.7. Collaborate with health information management (HIM) to validate findings.8. Present findings to Chief Nursing Officers, as well as wound care nurses and physical therapists.9. Work with information technology EHR builders to build the data base related to ICD-10-CM that is needed for nurses to document in the EHR.10. Prepare educational materials for staff nurses regarding the changes in pressure ulcer documentation for ICD-10-CM.11. Pilot education materials among staff nurses, making adjustments as needed.12. Disseminate educational materials/offerings regarding nursing documentation of pressure ulcers related to ICD-10-CM. …