ICD-10 Diagnosis and Procedure Dataset Updates and DRG Definition Improvement

By Morgan Atkins

The Stratasan team is continuously looking for ways to improve our customers’ experiences and add value. With the switch to ICD-10, many healthcare organizations were tasked with a plethora of new codes to understand and define into main and sub-product lines. One of our recent initiatives has been to update our ICD-10 diagnosis and procedure definitions so that customers are no longer subjected to large chunks of data falling into the “undefined” category. Through this process, it was determined that our previous ICD-10 definition nomenclature could use some refinement as well. We decided to start fresh with new definition categories to create a uniform analysis experience.

While updating ICD-10 definitions, we recognized our DRG definitions needed to follow a similar naming structure so that users could have uniform analyses. We took the opportunity to also revamp our DRG definitions so that we would have cohesive naming conventions across all code-types.

We are happy to report that this update is complete and that current Stratasan product line definitions will be updated on March 1st.

Continue reading for a full explanation of the process of updating our product lines, the history of ICD-10, and a quick summary of what changes have been made.

The Full Story

On October 1st, 2015, the United States transitioned to utilizing a 10th revision of the World Health Organization’s International Classification of Diseases, also known as ICD-10. The ICD-10 system exceeds its predecessors with the level of detail shown and the number of codes offered. ICD-10 codes help physicians provide better documentation of patient interactions, which can lead to better justification of their clinical decisions, therefore leading to fewer denials of claims. While this newfound specificity will amplify the healthcare industry’s ability to interpret clinical data moving forward, the transition period did not come without growing pains.

A few key differences between ICD-9 and ICD-10:

  • ICD-9 codes had around 13k codes, ICD-10 has 68k.
  • ICD-10 allows for identification of etiology, anatomic site, laterality, and severity. It also can identify the encounter: initial, subsequent, or sequelae. ICD-9 codes may identify “fracture of leg,” but ICD-10 will let you know it was “the upper end of the tibia on your right leg and a closed fracture.”
  • ICD-10 codes allow room for new technologies or diagnoses to be documented.

With the transition to ICD-10 codes, healthcare coders were tasked with determining which codes to use and when. For any given diagnosis or procedure, they were familiar with which ICD-9 code to use, now they were being required to translate those same diagnoses or procedures into a new coding system. In order to study trends, healthcare analysts need to categorize codes so they can see movement among product lines and sub-product lines. In order to analyze trends, ICD-10 codes need to be categorized with the same nomenclature and methodology as ICD-9. Due to the sheer number of how many more ICD-10 codes there are and the level of detail they provide, creating consistent nomenclature is no easy task.

The National Center for Health Statistics (NCHS) developed several helpful tools to assist with the transition. One such tool, General Equivalence Mappings (GEM) attempt to find corresponding codes between ICD-9 and ICD-10 to the best extent possible. Some codes have one-to-one translations where one ICD-9 code is a direct equivalent to a certain ICD-10 code. However, with the aforementioned reasons for transitioning to ICD-10, there are several codes that do not have just one ICD-9 equivalent or any at all. This causes interpreters to have to make judgment calls or compromises when defining product lines.

Up until now, Stratasan used a methodology called “Forward Mapping” to categorize the ICD-10 codes into product lines and sub-product lines. This method takes the ICD-9 code definitions and applies that to their ICD-10 counterpart. Several problems arose with this method. First, due to there being so many new codes and increased specificity, there were thousands of ICD-10 codes that did not crosswalk into a product line. Second, we found that several codes were not being placed into the most reasonable category. Despite having an ICD-9 equivalent, sometimes our definitions were not translating appropriately to the ICD-10. While sifting through the ICD-10 code definitions, it was also determined that Stratasan’s diagnosis product lines and sub-product lines could use some attention and improvement. We saw room to upgrade our definitions and create more concise definitions that would ease the burden of analysis.

At this point, we knew we were going to have to take on the daunting task of “Backward Mapping.” This method categorizes the ICD-10 codes first and then utilizes the GEM to define the ICD-9 equivalents. We could have taken the easier route with Forward Mapping, however, we knew the rewards of having a fresh nomenclature for the diagnosis product lines would be worth the work. We decided the ICD-10 codes should not be defined based off of a code system that is now outdated.

So, where did we start?

Luckily, ICD-10 codes are already grouped by what we would consider to be the “main product line,” for the most part. However, in some of those groups, it is not as simple as considering the entire group’s main product line to be the same. In order to identify which main product line a diagnosis belongs to, we pulled public inpatient datasets and added in our DRG crosswalk as well as ICD-10 diagnosis codes. From there, we were able to see the dominant DRG product line that any given diagnosis code was associated with. This step of the process led us to realize that our DRG to product line crosswalk could use some work as well. We saw opportunities to create more concise groups, as well as better overall definitions. Once both DRG and diagnosis codes were defined, we moved on to procedure codes and followed the same nomenclature.

Below is a summary of the IDC-10 diagnosis and procedure dataset updates:

  • Many of the above changes made to DRGs carried forward to diagnosis, such as Infectious Disease being a sub-product line, psychiatry and substance abuse rolling into Behavioral Health, more detail with sub-product lines
  • Due to the addition of several diabetes diagnoses, a product line of “Endocrinology” was added rather than rolling up all of those diagnoses into General Medicine
  • Infectious Disease and Adverse Effects are now sub-product lines
  • Diagnosis main and sub-definitions now use consistent nomenclature as DRG, when possible
  • Orthopedics and Gastroenterology sub-product lines describe the body part involved with the diagnosis

Below is a summary of some of the DRG dataset updates:

  • Substance Abuse and Psychiatry are now rolled up into one product line called “Behavioral Health” with each of those previous main categories now being the sub
  • Vascular Surgery is now “Vascular Services” due to some of the DRGs being medical and not surgical. Sub-product lines now describe if the diagnosis was surgical or medical in nature.
  • We had several sub-product lines that were various iterations of describing an infection, they are now all consistent with their sub being “Infectious Disease”
  • All carotid artery procedures fall under Neurosurgery
  • Several Otolaryngology sub-product lines are now rolled up into “Oral” instead of multiple different subs
  • Several sub-product lines have newly added detail of the specific body regions they are associated with
  • DRGs previously with the sub-product line “Liver” are now rolled into “Biliary/Pancreas” due to many of those DRGs often being associated with a region larger than just the liver
  • The sub-product line “Wound Care” has been changed to “Skin/Wound” to account for the larger variety of diagnoses that can be attributed to these DRGs
  • Urology sub-product lines now identify whether the diagnosis was surgical or medical
  • Obstetrics now has sub-product lines to identify postpartum, abortion/miscarriage, and antepartum/high risk
  • Adverse effects is now a sub-product line of either General Medicine or General Surgery to create more concise product lines
  • General Medicine sub-product lines of allergic reactions, toxic effects, and other injury are now all rolled up into “Injury/Poisoning”

The Takeaway

For all Stratasan customers who use our platform, ICD-10 diagnosis and procedure datasets, and DRG definitions, we knew this would be an important announcement. This update means we now have a more cohesive naming convention for all of our product lines. We took out redundant categories and rolled up some that no longer needed to be stand-alone. Users now have an increased ability to compare product lines across different code sets. Also, when utilizing ICD-10 diagnosis or procedure definitions, users should see a major impact on how many codes are no longer “undefined.”

All of this was done in an effort to improve our customers’ experiences and add value. If it would be helpful for you to see, we have retained a detailed Excel document listing specifically which DRG codes changed, what their previous definition was, what changed (main or sub), and why. If you would like to access this document or have any other questions related to this update, please contact your Customer Success Manager or reach out to us at support@stratasan.com.

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