ICD-10-PCS and HL7 standards in healthcare implementation

Healthcare Standards

there are three parts. PART A REQUIRES 4 DIFFERENT ANSWERS

Standard: ICD-10-PCS

"ICD-10-PCS is intended to replace ICD-9 volume 3 for facility reporting of inpatient procedures….ICD-10-PCS is a totally new coding system designed to better accommodate the rapidly changing world of procedures. The code system was developed in the 1990s, but use of the continually updated codes will start almost 20 years later." (Dimick 2011). This new standard is supposed to be more accurate and reflective of current healthcare realities than standards of the past, but it is uncertain if in its implementation this promise will be realized.

Current status of implementation

This standard has yet to be fully implemented. "On October 1, 2013, healthcare providers must begin reporting HIPAA claims using the ICD-10 counterparts to the current ICD-9 code sets" and full implementation will be a 20-year process (Dimick 2011).

Three major issues related to implementation status

Little research exists regarding its ease of use or even of its practical efficacy. "Outside of a pilot study focused on ease of use, little practical knowledge exists concerning the ease or efficacy of coding procedures in the code set" (Dimick 2011).

New standards have been implemented in terms of defining anatomy, regarding a radical shift to how coding is implemented: "ICD-10-PCS has its own way of describing anatomy" (Dimick 2011).

In an effort to make the coding more precise, potential applications are "somewhat problematic. For example, excision is defined as 'cutting out or off, without replacement, a portion of a body part' while resection is 'cutting out or off, without replacement, all of a body part.' If a surgical procedure involves the removal of part of one body part and all of another (e.g., thyroidectomy with removal of local lymph nodes), how is it coded? The basic answer is that multiple codes are applied" (Dimick 2011).

The practice implications of either having or not having this standard in place

However, not implementing the standard is still more problematic. Much has changed in medicine and a radical updating to the coding system is demanded. The ability to continually update codes is also required in today's ever-changing environment, and this alterability is a critical feature of the new standard.

Part C: Practice implication of not having a Standard ASC X12

While HL7 enables comparing and sharing of medical data providers, ASC X12 enables the sharing of such information between professionals involved in the financial side of healthcare: Standards "facilitate electronic interchange relating to business transactions such as order placement and processing, shipping and receiving information, invoicing, payment and cash application data, and data to and from entities involved in finance, insurance, transportation, supply chains and state and federal governments" (About ASC X12, 2013, ASC X12). Being able to compare the costs of treatment and the business expenses of healthcare enables institutions to engage in quality control 'benchmarking' and identify areas where savings may be found without compromising patient care. It also serves to facilitate more streamlined business transactions.