Coded data represents the foundational elements for healthcare decision-making, research, quality of care, monitoring of population health, pay for performance, payment, disease management, clinical registries, fraud and abuse monitoring and identification, and injury monitoring.
These few words are similar to those I provided in April 1996, when I gave testimony at the Subcommittee on Health of the U.S. House of Representatives House Ways and Means Committee in support of ICD-10-CM/PCS code set adoption. These words remain true today, and even more so now that we are actively using the ICD-10 code set and moving the focus for payment to quality rather than quantity in healthcare. The key, however, is the integrity and accuracy of the coded data, which should not and must not be taken lightly. The value of coded quality and data integrity is one that truly can be labeled immeasurable.
When we talk about ICD-10 coding quality and data integrity (including CPT, Current Procedure Terminology and HCPCS, Healthcare Common Procedure Coding System), we often relate that to accuracy, which is the normal thing to do. The terms “integrity,” “data integrity,” and “accuracy” have the following definitions in the dictionary:
It’s the “coding professional” who has the knowledge, skill, and ability to review, investigate, synthesize, and translate the available clinical and physician documentation into accurate codes that then compliantly tell the story of each patient’s encounter. The coding professional through this process strives to achieve coding accuracy that will result in data integrity.
Tracking and trending coded data over time frames is essential to the work that we do in healthcare, and specifically, in health information management (HIM), including coding professionals in all settings. Comparing diagnosis and procedure code frequencies across months and even years can provide insight into a vast sea of information. Have you performed this level of monitoring?
With encounter data now being submitted by providers and captured for payment analysis and determination, coded data is at the core of payment models and future payment models. It’s at the core of quality reporting and future quality reporting. It’s at the core of research and outcomes. If we choose not to code something that is codeable and reportable due to time constraints and other challenges, then we are not being complaint nor true with data submission, and therefore not achieving data integrity. Ultimately, this type of practice affects decisions being made on healthcare for the future on many levels.
In conclusion, our healthcare system cannot continue without coding quality, accuracy, and data integrity. We must stay vigilant in our efforts to provide education, auditing, and monitoring, as well as assessing our ethical standards along the way. It’s important to assess coding practices to validate and ensure that all reportable data is being obtained and submitted via the coding processes.
We now have a better coding classification system with ICD-10, and we are moving to an era where quality will be significantly judged, whether evaluating hospitals, physicians, nursing homes, etc. Affirming that the all ICD-10-CM/PCS codes are accurate and the data used has integrity is something not be ignored, and our future healthcare depends and demands this. We must take and make every possible effort to ensure that we have and continue to have coded data integrity. As healthcare professionals, and especially health information management coding professionals, we have an obligation to work diligently towards coding integrity.
Now let’s go out there and make coding quality and data integrity happen!
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One of the biggest issues I find when working with clinical documentation integrity (CDI) departments is that the hospital clinical revenue cycle remains siloed. Rather
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