Are you ready for the pain of ICD-10?
Vijay Pandiarajan 270003VJ4Q email@example.com | | Tags:  brms wsj macaw decision-management icd-10 lamp-post
0 Comments | 1,800 Visits
I was chuckling when reading this recent WSJ article that gently pokes fun at some of the new codes that doctors will have to use when filing insurance claims starting in Fall 2013. Most of us have experienced some of the existing codes. I'm most familiar with 381.00: Acute otitis media; having taken my 5-year-old in several times to treat an ear infection.
The WSJ article discusses how the new system known as International Classification of Diseases, version 10 or ICD-10, has so many more codes. 140,000. Up from the current system of 18,000 codes. In this attempt to improve the quality of care by collecting more data, some of the codes border on silliness. For example, there are separate codes for walking into a lamp post the first time and another one for a repeat performance. There are also nine different codes for Macaw mishaps. There are even separate codes for whether you get “bitten by a turtle” or “struck by a turtle.” Yes, I kid you not. Remind me to steer clear of turtles, especially the striking kind.
While this makes for some light reading, there are some huge challenges ahead for the systems that process these insurance claims. By October 1st of 2013, all US hospitals and insurers must switch to these codes and that's a huge undertaking depending on the current state of IT systems. It made me think that the people who already use a Business Rules Management System (BRMS) are not sweating this at all. 18,000 or 140,000 codes, it doesn’t matter because they’re not hard-coded. If you have all your decision logic burnt into computer code, this will hurt like a ton of bricks (which is probably another code). Just figuring out where all the current codes are in the computer program can be a nightmare, and then they must be re-coded, tested and put into production again.
Those that have a BRMS implementation with the codes isolated and defined in a visible natural language style, can have their users view and update the new codes, specifying when they should be used, directly into the system. Perhaps a few data entry operators could be hired to do it, while IT staff time is better allocated to ensuring the system’s reliability or working on the next strategic project. Granted, it will take a while to get all 140,000 added, but it will be orderly, relatively painless, and without a great sense of panic.