ICD 10 Codes Will Drive Quality in Healthcare

Quality, Privileging Software, OPPE, ICD Codes, ICD-10, Privileging, CPT CodesIntegrating ICD 10 codes throughout your organization is essential in not only meeting requirements for billing, but more importantly, can provide insight in delivering the highest level of “quality healthcare”. Understanding the ICD 10 codes, and how they can impact all of healthcare, is a necessity for any health care professional or medical services provider.

Global Standard

Every year since 2002, the World Health Organization, part of the United Nations, has released a list of standardized codes for every disease and injury known to medical science including a unique code for signs and symptoms including a range of related factors. The current list, the tenth, is known as the International Statistical Classification of Diseases and Related Health Problems or ICD 10.

Utility of ICD 10

ICD 10, currently in practice in more than 25 countries, encompasses more than 68,000 codes and sub-codes with the ability to describe and detail new discoveries. This granularity is a quantum leap from the 13,000 codes provided under ICD 9. More importantly, ICD 10 establishes a framework where healthcare facilities, their medical staff and associated healthcare service providers can communicate. It‘s the fastest and most efficient method to ensure all involved in the continuum of care are on the same page.

The ICD 10 serves to enhance insight in analyzing care provided to patients. At a high level, oversight and audit committees can review case files to ensure prescribed diagnostics and treatment delivered align with those prescribed by medical “best practice”. Oversight extends to the billing process enabling insurers to be confident services paid for are the services rendered, ensuring an accurate “performance level” when accreditation audits are preformed.

Impacting Your Business

Simply put, 21st century medicine embodies vast, diverse and evolving information with no end of expanse in sight. No one person can understand every facet, thus the only way to accurately manage and capture value from this colossal amount of information is to standardize it.

Healthcare organizations worldwide must embrace standardization or the benefits of learning from all the data we aggregate will be lost. With mandates driving improvement and the internal desire to deliver quality healthcare, most in the United States are on their way to utilizing electronic health records (EHR) management systems enabling ICD 10. These companies are poised to lead their communities in growth, succeed in delivering the highest level of quality healthcare and support the World Health Organization in understanding healthcare globally.

In addition to the need of electronic health records in aggregating information, it’s equally important to understand the need to tie the very same ICD 10 codes to the delineated privileges within your organization. Utilizing a system to manage the link between an ICD 10 code and the associated privilege can afford organizations with unique, timely insight of actual procedures performed against privileges granted. Moreover, it closes a gap between credentialing and quality by reporting on and confirming a provider is not only performing privileged procedures but performing the required number of procedures to retain privileges granted.

Bottom Line

Currently, ICD 9 is in effect with ICD 10 looming and scheduled for debut in October, 2014. ICD protocols have demonstrated an effective standardization and been proven valuable across all healthcare services. Their use has improved every aspect of medicine from diagnostics through treatment to billing. The adoption of ICD 10’s is simply an evolutionary necessity in meeting the need to understand what we’ve done, measure what we are currently doing and effect change in the future of what we do to deliver a continuum of quality care globally.

Provider Credentialing


Julie Costa-Bickmore, CPCS

About the Author
Julie Costa-Bickmore, CPCS

Julie Costa-Bickmore, CPCS is symplr’s credentialing / privileging consultant, with more than 25 years’ experience working as a consultant with medical staff office, administration, and physician leadership teams in hospitals and other healthcare facilities nationwide. She developed the privileges and threshold criteria content for the symplr privileging database. Her primary focus area is the development of core privileges and threshold criteria for special procedures, as well as the quality of the credentialing process.

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