Healthcare News & Insights

ICD-10: Why the switch could hurt hospital patient safety ratings

459646933ICD-10 implementation will be happening in less than a year – and along with the potential disruption to your hospital’s billing operations, it could also adversely affect your patient safety ratings.

Currently, safety ratings are determined by how frequently a facility reports certain ICD-9 codes. Along with government organizations like the Centers for Medicare & Medicaid Services (CMS), other patient safety groups use these codes to figure out how often certain adverse events happen at a hospital.

Specifically, the Agency for Healthcare Research and Quality (AHRQ) used ICD-9 data to create its patient safety indicators. If a hospital fails to meet the standards set by these indicators, it’s a black mark against the facility’s record.

Hospitals’ performance toward meeting these safety measures is released to the public in many ways, via reports and websites. These numbers are becoming more and more important to patients – along with payors and the feds – because of healthcare reform and its focus on providing low-cost, high quality care with fewer preventable complications.

Few direct matches

Although ICD-10 is supposed to help hospitals keep more detailed healthcare records for patients, it may actually lead to some inaccuracies when it comes to tracking patient safety indicators. Reason: Because many ICD-9 codes don’t have a specific ICD-10 equivalent, some diagnosis info may be lost in translation with the switch.

A recent analysis in the Journal of the American Medical Informatics Association (JAMIA) specifically looks at several ICD-9 codes using the General Equivalence Mappings (GEMs), which are designed to help coders figure out how ICD-9 codes would translate into ICD-10.

With the help of the GEMs, researchers compared current patient safety indicators, created with ICD-9 in mind, with recommended ICD-10 codes. Their goal was to see if the patient safety indicators matched up with the ICD-10 equivalents for current ICD-9 codes.

Out of 18 patient safety indicators using ICD-9 data, only three had straightforward ICD-10 equivalents. The others were more complicated and linked to multiple ICD-10 codes.

Because there aren’t many direct matches, this could lead to issues when determining how well a hospital is meeting patient safety standards, which means that safety ratings may not be as accurate once ICD-10 is implemented.

While the AHRQ is working on making its patient safety indicators ICD-10 ready, because of the complexity of the new code set, it may still be difficult to avoid reporting issues entirely.

Potential effects

In cases where multiple ICD-10 codes could be linked to a single adverse event, it’s possible for over-reporting to occur. The same patient encounter billed with several related ICD-10 codes could be counted against a hospital multiple times.

On the other hand, hospitals may end up under-reporting adverse events — if the new criteria for coding a condition are so different, they don’t match up with a safety indicator at all.

Researchers gave an example about how changes to the way complications due to foreign bodies are reported can lead to inaccurate recordkeeping.

Currently, the patient safety indicator relating to foreign body injuries only counts the initial patient encounter. ICD-10 has different codes for subsequent encounters, and while they should also be included in the data for adverse events, they won’t be if the AHRQ uses the same rationale for ICD-10 safety indicators as it does for ICD-9.

And because the new codes relating to foreign body injury include new details that aren’t covered in the current patient safety indicator (such as related adhesions, perforations and obstructions), encounters for these additional complications may not be counted, either.

Another factor to consider: Because there are more diagnosis codes that hospitals can use in general for encounters, there may be more gray areas when it comes to selecting codes. Depending on your coders’ training, or how your billing software or electronic health records (EHR) system interprets providers’ documentation, it may be difficult to determine which code is appropriate for the encounter.

And any coding mistakes or misinterpretations could cause your hospital’s safety ratings to plummet.

Heading off problems

Since inaccurate diagnosis inforomation could lead to serious consequences for hospitals if it negatively affects their patient safety ratings, it’s important to make sure your IT department is aware of the potential for these issues to arise as the ICD-10 transition moves forward. That way, IT can ask your EHR vendors about whether the ICD-10 version of the system will select codes automatically, and how it determines code selection if it does this.

It might be best to disable this feature, at least for the initial months of ICD-10, and rely on coders’ expertise to come up with appropriate codes.

You may want to tell hospital coders to specifically keep their eyes on the diagnosis codes that affect hospital’s performance with patient safety indicators.

Also, it’s a good idea to review your coding procedures to be sure they’re free of any major issues now, and let clinical staff know what info needs to documented in the medical record to keep diagnosis coding accurate in ICD-10.

Keeping accurate records is the best defense against discrepancies with safety scores. Your hospital will be able to figure out what really happened during a patient encounter – and use that as proof if your facility’s safety protocol is ever called into question by a low safety rating.

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