By Lisa A. Eramo
It’s a fact: without clinical coded data, population health monitoring (PHM) programs could not function. PHM programs are all about the data. The data tells a story that public health professionals and others can read, bookmark, and re-tell in order to predict outcomes and develop strategies for prevention.
Health information management (HIM) professionals play a crucial role in this type of storytelling because they are the ones who actually capture the data. Whether they use the help of an encoder, computer-assisted coding, or a variety of other health information technologies, HIM professionals have the “final say” in the clinical data that is recorded via codes on a claim.
It’s incredibly important for HIM professionals to tell a complete story and capture as many relevant codes as possible. The American Health Information Management Health Association’s (AHIMA’s) Standards of Ethical Coding require HIM professionals to capture “all healthcare data elements (e.g., diagnosis and procedure codes, present on admission indicator, discharge status) required for external reporting purposes (e.g., reimbursement and other administrative uses, population health, quality and patient safety measurement, and research) completely and accurately, in accordance with regulatory and documentation standards and requirements and applicable official coding conventions, rules, and guidelines.”
Although ICD-9-CM (the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States—ICD-9-CM stands for International Classification of Diseases, Ninth Revision, Clinical Modification) provides valuable clinical detail, there’s no doubt that ICD-10-CM (an even more detailed revision) will help PHM programs grow to a new level. According to the Health Resources and Services Administration, ICD-10 is “the standard coding system for epidemiology, health management and clinical purposes, including the analysis of the general health situation of population groups, in World Health Organization member states. It is used to monitor the incidence and prevalence of diseases and other health problems.”
ICD-10-CM includes far greater specificity that can only help PHM programs. For example, many ICD-10 codes specify laterality (i.e., left, right, or bilateral). Fourth, fifth, and sixth characters allow for greater expansion. Some codes include a combination of the diagnosis and symptoms to reduce the number of codes needed to fully describe a condition.
In an AHIMA article titled “Why ICD-10 Is Worth the Trouble,” Sue Bowman, RHIA, CCS, wrote that ICD-10 codes for external causes of injury will be a game changer in PHM. She said, “External cause of injury codes are also much more detailed in ICD-10-CM than in ICD-9-CM. This coding provides a framework for systematically collecting population-based information needed to fully describe and document how and where injuries occur. The codes are important for injury surveillance and for designing, implementing, and monitoring injury prevention and control programs.
In June 2007, Perspectives in Health Information Management published an article titled “The Effectiveness of ICD-10-CM in Capturing Public Health Diseases,” that details a research study conducted to examine the usefulness of the ICD-10-CM system in capturing public health diseases and particularly these top ten causes of death for 2002:
- Diseases of the heart
- Malignant neoplasms
- Cerebrovascular diseases
- Chronic lower respiratory diseases
- Accidents (unintentional injuries)
- Diabetes mellitus
- Influenza and pneumonia
- Alzheimer’s disease
- Nephritis, nephritic syndrome and nephrosis
The study found that ICD-10-CM fully captures more public health diseases than ICD-9-CM. Authors of the study concluded the following: “The use of ICD-10-CM has great implications for our entire nation since public health diseases, which include epidemics and other diseases related to bioterrorism, are generally able to be captured in a more specific way when using the ICD-10-CM system. This can be seen for all public health reportable diseases, diseases related to the top ten causes of mortality, and diseases related to terrorism.”
Clinical coded data will continue to play a significant role in the development and expansion of PHM programs. As stewards of the medical record, HIM professionals must be prepared to explore ways in which this data can be used to improve care and public health.
To find out more about health information management and how you can earn a degree in this exciting field, visit the UW Health Information Management and Technology degree page or call 1-877-UW-LEARN (895-3276) today.