Friday, September 23, 2011

6 Considerations for Verifying ICD-10 Operational Neutrality

Lately, I’ve been reading and hearing a bit of chatter about “ICD-10 verification and validation strategies” with the concept of verifying “financial neutrality” and/or “benefit neutrality” a dominant concern.  One of these days I think I’ll share my thoughts on those aspects of ICD-10 testing. But the purpose of this post is to raise a few areas of ICD-10 testing that may be considered as verifying “operational neutrality” and which, if not verified as working correctly, will certainly impact “financial neutrality” and/or “benefit neutrality.”

Note: The following is relative to ICD-10 Diagnoses codes and targeted toward healthcare payers, though many also apply to healthcare providers. Consult with your knowledgeable ICD-10 coding professional for more information.

ICD-10 impacts to verify and validate include:

1. Identifying “External Causes” or “E Codes” for Other Party Liability (OPL) processing.

{These are easily identified in ICD-9. In ICD-10, it isn’t going to be as easy as looking for codes that start with an “E”}

2. Body part assignment logic associated with OPL investigations

{Besides needing a new “ICD-10 code to Body Part cross-reference table,” you’ll need to be able to link claims received prior to 10/1/13 coded with ICD-9 codes to claims received after the 10/1/13 compliance date coded with ICD-10 codes}

3. Processing of Status Codes (aka. V Codes). These are codes designed for occasions when circumstances other than a disease or injury result in an encounter or are recorded by providers as problems or factors that influence care.

{This is a challenge similar to the “E” codes noted above.  The AHIMA recently put out some good info on this topic.  See “From V Codes to Z Codes: Transitioning to ICD-10” for more info.}

4. Validating logic and output related to Episodes of Care. You’ll have to be able to link/associate claims coded in I-9’s and I-10’s.

{This is a major area to validate and actually a subject beyond the scope of this short post. Check back later for more info.}

5. Correct handling of “combination codes.” ICD-10 can represent these with a single code as opposed to two or more sequenced codes in ICD-9.

{This is an area where I think considerable assistance from your ICD-10 coding expert will be required}

6. Verifying that searching, sorting and list processing algorithms work as expected

{I’ve seen source code logic that strips leading alpha characters out and presents ICD codes based on numerical collating sequences.  These would likely require revision.}

For more information regarding how ICD-10 will impact payers and providers, be sure to follow me on Twitter: ShimCode

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