A final HIMagine That: Looking back…and ahead

January 15th, 2018 / By Sue Belley, RHIA, Donna Smith, RHIA

Donna: Sue, do you remember when we started our blog back in 2012? Didn’t the idea present itself at a conference we were attending?

Sue: Yes, it did! We were having quite a lively back and forth conversation about the upcoming transition to ICD-10 and someone on our blog team overheard us. After listening in, they asked us to consider blogging our discussions.

Donna: And here we are in 2018. ICD-10 has been implemented and the classification is being updated yearly to work out the kinks, just like it did with ICD-9 all those years ago.

Sue: Yes, and what I predicted then has come to pass: Adopting an improved classification system has allowed us to specifically identify conditions so that our data is more accurate. Big data has always been used to drive healthcare reform and I worry when it isn’t specific enough to correctly identify disease states.

Donna: Not surprising, I agree! The latest update has new codes for myocardial infarctions and heart failure to better classify those conditions. Physicians have been complaining about the fact that the classification system did not allow them to better specify different types of heart failure other than systolic and diastolic.

Sue: The strides we’re making nationally to improve provider documentation go hand-in-hand with the improvements in the classification system. I think the recent addition of guideline #19 to the ICD-10-CM Official Guidelines for Coding and Reporting is a good example of this. The guideline states that the physician’s documentation of a diagnosis is sufficient enough to allow for code assignment and that code assignment is not based on the clinical criteria used by a provider to establish a diagnosis. I know this caused some outcry, but we saw the 4th Quarter 2017 Coding Clinic reinforce the new guideline. Another big change in the coding world is the guideline stating that a coder must assign a code for a diagnosis documented by a physician. This has also been reinforced by the 4th Quarter Coding Clinic. So many providers were establishing clinical criteria for the coders to use to determine the appropriateness of assigning a code to a disease documented by a physician.

Donna: I agree. This particular guideline has challenged Clinical Documentation Improvement Specialists as they must carefully compose a query to a physician, saying something like “Are you sure this diagnosis is correct?”. . . Just kidding! Actually, the joint AHIMA-ACDIS Query Practice Brief offers some good examples of wording for this type of query.

Sue: I don’t know if ICD-10 will be around for 30 years like ICD-9. I certainly hope we continue to migrate to new and better coding classification systems before then, and I also hope we are on a better path to insuring that our coding keeps pace and is truly representative of the diseases and conditions our patients have and the procedures they undergo.

Donna: Maybe ICD-10 won’t be around for 30 years as ICD-11 is on the horizon.

Sue: Let’s hope so! Well, after another year with ICD-10, is there anything left to say?

Donna: Yes there is! I started my career with ICDA-8 and I am ending it with ICD-10 . . .

Sue: What?!?!

Donna: I am hanging up my HIM hat and starting my new career!

Sue: And what career would that be?

Donna: Retirement! I can’t believe I have been in this field for so long. It’s been a long, winding and interesting road for me and I’ve loved every minute of it!  

Sue: Oh Donna, how I’m going to miss our conversations! I’ve been inspired by your knowledge and passion for coding and documentation. Happy New Year and best wishes on your next adventure!  And, just remember, I have your phone number and email address . . . the next time I’m facing a real coding conundrum, I know where to find you!

With this final HIMagine That blog post, the Inside Angle blogging team thanks Donna Smith for lending her expertise to the blog and for her contributions over many years to 3M Health Information Systems and the HIM profession. Find links to some of Donna’s recent work below and you can send a message to Donna in the comments section. Watch for future blogs from Sue Belley!

Sue Belley, RHIA, Donna Smith, RHIA, are with the consulting services business of 3M Health Information Systems.


More from Donna Smith:

The role of HCCs in a value-based payment system

Embrace risk adjustment

Sepsis denials management