Journal of AHIMA - June 2011

efficiently and effectively assist other departments organization-wide in their conversion efforts. By automating much of the conversion effort, organizations can focus HIM resources on resolving conversion issues such as the diabetes example previously discussed.

Beyond the immediate challenge of converting the wide array of ICD- 9–based systems to ICD- 10, there are the longer-term opportunities afforded by ICD- 10.

With the detail available in ICD- 10, demand to express clinical concepts in ICD- 10 codes will grow dramatically. Departments such as utilization review and quality assurance will want to use ICD- 10 to create operational systems that monitor utilization and quality at a level of precision not possible under ICD- 9.

Contract negotiations with payers will inevitably evolve to more precise coverage, guidelines, reporting, and other rules based on ICD- 10. ICD- 10 will also require more complete, precise, and accurate documentation. Developing and maintaining systems and improvement programs that benefit from the detail of ICD- 10 will require the expertise of HIM professionals for their long-term success.

The implementation of ICD- 10 is the most significant event for the HIM profession since the adoption of DRGs for Medicare payment in 1983. Healthcare reform, pay-for-performance, and public comparisons of efficiency and quality will create increasing demand for accurate and complete data. The additional

ICD- 10 Fine Print

specificity of ICD- 10 is essential for achieving these objectives. For HIM professionals, ICD- 10 represents both an immediate challenge and a long-term opportunity. ¢

References

AHIMA. “Putting the ICD-10-CM/PCS GEMs into Practice.”

Journal of AHIMA 81, no. 3 (Mar. 2010): 46–52.

Centers for Medicare and Medicaid Services (CMS). “Converting MS-DRGs to ICD-10-CM and ICD-10-PCS.” www.cms.gov/ICD10/17_ICD10_MS_DRG_Conversion_ Project.asp.

CMS. “General Equivalence Mappings.” www.cms.gov/ICD10. asp.

CMS. “General Equivalence Mappings: Technical Documentation for Users.” www.cms.gov/ICD10/11b1_2011_ICD- 10CM_and_GEMs.asp.

Mills, Ronald E., et al. “Impact of the Transition to ICD- 10 on Medicare Inpatient Hospital Payments.” www.cms.gov/ ICD10/ 17_ICD10_MS_DRG_Conversion_Project.asp.

Rhonda Butler ( rrbutler@mmm.com) is a research analyst and software development specialist in the department of clinical and economic research; Ron Mills is a software architect and division scientist for health information systems; and Rich Averill is senior vice president of the department clinical and economic research at 3M Health Information Systems.

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