well as laterality (right versus left). Measures evaluating patients
with stage 3 and 4 pressure ulcers will need to identify all the
new ICD-10-CM location codes specified as stage 3 and 4.
Myocardial infarction codes have undergone a definition
change as well. Under ICD-9-CM a myocardial infarction is coded as acute if it has a duration of eight weeks or less. This time
period is four weeks under ICD-10-CM. In addition a new three-character category code has been created to identify a second
acute infarct occurring in the four-week time period.
Measures using myocardial infarction codes will need to be
reviewed to determine what ICD-10-CM codes to include, and
the time period change will need to be considered when comparing ICD- 10 measures to their ICD- 9 counterparts when differences in volume or outcomes are noted.
Situations like these will need to be evaluated for all quality
measures to determine if there could be a significant difference
in the composition of the measure and whether these measures
are even comparable.
In the long term, as more clinical data are captured under
ICD- 10, measures will be refined to take advantage of the increased specificity such as procedure-based measures. ICD-
10-PCS provides greater specificity for identifying procedures
by approach, location, and device use. Stratifying or focusing
a measure based on the type of approach, such as open versus
laparoscopically, will offer greater insight into process of care
and outcomes like infections or mortality.
As measures are refined and modified to take advantage of
ICD- 10’s specificity, they will move further away from comparability with older ICD- 9 data and require that end users understand how these changes will affect the patient population and
intent of the measure.
As measures are refined and
modified to take advantage of
ICD- 10’s specificity, they will move
further away from comparability
with older ICD- 9 data.
Preparing Quality Measures for ICD- 10
So what can be done to prepare for transforming quality measures to ICD- 10? As with the other aspects of the ICD- 10 implementation, planning is the first step. Planning should encompass both internal performance measures used within the
organization as well as measures reported externally.
Everyone is learning ICD- 10, and a thorough review of the
code set conversions and measure specification changes based
on ICD- 10 will increase the accuracy and completeness of the
revised measure definitions. Each organization will need to determine what effect these updated definitions may have on its
data and identify potential issues that should be addressed.
ICD- 10 Detail on Fracture Site
A PATIENT WITH a diagnosis of displaced right intertrochan-
teric fracture has an open reduction with internal fixation pro-
cedure performed. The following ICD-9-CM diagnosis and
procedure codes would be assigned:
x 820.21, Displaced intertrochanteric fracture
x 79. 35, Open reduction of fracture with internal fixation,
However, ICD-10-CM codes provide more detail about
the fracture diagnosis and procedure:
x S72.141A, Displaced intertrochanteric fracture, right
femur, initial encounter for closed fracture
x 0QS604Z, Open reduction of fracture with internal
fixation, right upper femur
Planning should include:
x Educating measure stakeholders on the change to ICD- 10
and soliciting support for the measure review process.
x Creating a team to review measure data definitions, code
set conversions, and the impact of ICD- 10 on each mea-
sure. This team should include coders with ICD- 9 and
ICD- 10 training, analysts, and clinicians.
x Developing and prioritizing a measure review plan start-
ing with measures that have the most significance for your
organization in terms of patient volume and condition
and treatment classifications most changed in ICD- 10.
x Creating a data set for high-risk measures containing
both ICD- 9 and ICD- 10 coded data to evaluate the impact
of ICD- 10 on the measure. This activity can provide oth-
er benefits to the organization in terms of giving coders
experience in ICD- 10 coding, determining documenta-
tion improvements to take advantage of ICD- 10 increased
specificity, and starting to assess the productivity impact
of using the new classification.
x Preparing an assessment report for each measure sum-
marizing findings from the review team, recommenda-
tions for measure definition changes needed to support
the ICD- 10 code set, and education plans for measure end
users to understand the potential impact ICD- 10 will have
on the use of their measures. ¢
1. HIMSS National Quality Forum Task Force. “
Transitioning Clinical Quality Measures (CQM) from Abstracted to
Electronic Measures (eMeasures) Guidance Document.”
January 2012. www.himss.org/content/files/PSQO/
Kathy Giannangelo ( firstname.lastname@example.org) is an HIM consultant.