Developing a Database Remediation Strategy for Your ICD-10 Project

A database remediation strategy informs and guides the data modeling solution intended to bring consistency, ensure comprehensiveness, and provide strategic direction to your ICD-10 data modeling approach. If your organization has any internally developed applications and/or office applications, you should consider developing a formal database remediation strategy before your embark on updating your internally-developed applications to accommodate ICD-10.

Why do you need a Database Remediation Strategy? 

1.   ICD-10 codes have a different structure and composition (syntax) than ICD-9 codes. 

2.   The overlap between ICD-9 and ICD-10 codes that make it impossible to distinguish a specific code set (ICD-9 or ICD-10) on inspection. 

3.   Determining the type of code set depends on the data of service (professional claims) or discharge date (institutional claims) 

4.   The ability to access transaction history as ICD-10 codes become mixed with ICD-9 codes must be accommodated for the immediate period before and after the implementation date; and also to support mandated audit periods of up to 10 years. 

5.   Most organizations have a number of systems to remediate and some databases will require remediation in advance of the compliance deadline.    

What should your Database Remediation Strategy include? 

1.   A means to use data type and/or code attributes to facilitate logic for searching and matching single codes and ranges of codes.

2.   Use of a code indicator or prefix to discretely distinguish between I- 9 and I-10 codes. 

3.    Include attributes to facilitate accurate identification of professional vs. institutional processing logic and to provide the fidelity necessary for analytic reporting.

4.   Ability to capture both I-9 and I-10 codes to enable analysis and reporting.  Include attributes to identify how the code originated (native, converted GEM, converted custom, etc.,) translation version, potential duplicate mappings, confidence level associated with discrepancies between forward and backward mapping relationships. etc.

5.     A means to track remediation strategy used across multiple systems and scenarios with all applications using the same code set to ensure enterprise-wide consistency, compatibility and auditability. In addition, consider an approach for building a brand new data structure containing ICD Code attributes vs. extending existing structures.

Hopefully the above post provides some ideas for developing a database remediation strategy.  Stay tuned for a future post on topics related to ICD-10 logic remediation strategies.