ARRA on the Job / e-HIM Best Practices / Data Standards / Quality Care
ICD- 10’s Impact on Quality Measures
By Kathy Giannangelo, MA, RHIA, CCS, CPHIMS, FAHIMA, and Linda Hyde, RHIA
EACH YEAR THERE has been a significant increase in the num- ber of quality measures being used for public reporting across provider settings. Additionally, many of the new healthcare reform initiatives include quality measure reporting in their equirements. A small subset of National Quality Forum-en- dorsed quality measures were converted to electronic measures (eMeasures) format and published in the Centers for Medicare and Medicaid Services’ meaningful use final rule. A guidance document on transitioning clinical quality mea- sures from abstracted to eMeasures was published by the HIMSS NQF Task Force in January 2012. The report emphasized eMeasures depend on data standards and healthcare organizations need to prepare for more structured and standardized
data within the EHR. 1
While ICD- 10 was not selected as a data standard in stage 1
of the Medicare and Medicaid EHR Incentive Programs, it is included in the stage 2 proposed rule released in February. With
that probability, eMeasures will use ICD- 10 in addition to other
terminologies and classifications such as SNOMED CT, LOINC,
and RxNorm. The set of retooled eMeasures submitted to the
Department of Health and Human Services in December of last
year included ICD- 10 codes.
Organizations that have not started to evaluate the impact
ICD- 10 will have on their quality measure data should start now.
The Benefits of Greater Specificity
Quality measurement developers are finding ICD- 10 provides
detail where none existed before. This expansion means improved data for use in assessing patient severity, the quality of
care received, and patient outcomes.
An example of ICD-10-CM specificity not available in ICD-9-
46/Journal of AHIMA April 12
CM can be found in the fracture codes. A measure may require
reporting each occurrence of a hip fracture. However, ICD-9-CM
codes identify only the hip fracture. On the other hand, ICD-10-
CM codes provide detail on laterality and further specificity on
type of encounter—that is, initial or subsequent.
On the procedure side, ICD-9-CM is limited to the general site
of the fracture, whereas ICD-10-PCS is much more specific, as
shown in the sidebar at right.
ICD- 10 Definition Changes
ICD- 10 will impact quality measures in ways that will be felt for
many years after the implementation. Most quality measurement reporting is on a quarterly basis but includes comparative
and trending data that span calendar and fiscal year periods.
This means that measures reported using ICD- 10 data will be
either co-mingled with ICD- 9 data, such as a calendar year report, or be compared to prior periods for trending.
Over time the ICD- 10–based data will replace the ICD- 9 data,
but during the interim period it will be necessary to understand
what differences may be introduced in measures using ICD- 10.
In addition to the increased specificity, there are also important
definition changes taking place that will impact measures. The
following examples illustrate these changes.
Pressure ulcers are a significant condition used in quality measures for public reporting and as a healthcare-acquired condition
with payment provisions. In ICD-9-CM there are two different
sets of codes: one to identify the location of the ulcer and the other to indicate the stage or severity. There are only nine codes for
location, including upper back, lower back, heel, or ankle.
Under ICD-10-CM the stage and location are combined into
a single code, and there are more codes to specify location as
