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The Role of ICD-10 in Improving Business Goals

February 25, 2014

ICD 10 business GoalsOpposition to ICD-10 is strong from the AMA and other forces, due in part to the excruciating level of detail the new coding system demands. But that same deep level of detail may eventually be realized as a major benefit for advancing the goals of healthcare practices as well as the industry as a whole. Healthcare data mining and data analysis have already been benefiting the healthcare arena, and the deeper level of details ICD-10 promises to produce may increase the benefits even further.

ICD-10 Enhances Data Analysis

A quick review of some of the changes between ICD-9 and ICD-10 pointed out by the Centers for Medicare and Medicaid Services (CMS) make the increased precision immediately evident. The new system increases the number of codes, the numbers of characters in each code and adds more specificity to the coding process. ICD-10 allows for the description of etiology and causation, manifestations and complications, comorbidities, level of functional impairment, detailed anatomical location and other details not available with ICD-9.

CMS notes the switch can benefit healthcare providers by:

  • Accommodating more recently developed diagnoses and procedures
  • Allowing for innovations in treatment
  • Enhancing performance-based payment systems
  • Providing billing that is more accurate, streamlined and efficient

While such benefits can contribute to advancing the goals of a practice, ICD-10 may bring even greater benefits in the way of healthcare data analysis. An article published in the International Journal of Engineering Research and Applications points out the numerous benefits healthcare data mining can bring to the industry, and those benefits can be multiplied with the implementation of ICD-10.

Evaluation of Treatment

Healthcare data analysis can be a useful tool for determining the effectiveness of specific treatments. By comparing and contrasting the symptoms, causes and courses of treatment, healthcare data mining may play a role in discerning the most successful medication doses, therapies or other treatment modalities.

Management of Healthcare

Healthcare data mining software or applications could help identify and keep track of high-risk patients and chronic diseases. Analytical tools could help healthcare providers develop effective interventions, resulting in a reduced need for hospitalization and fewer overall claims.

Closely tracking specific conditions or ailments could also alert providers of a potential outbreak of infections, whether within the hospital parameters or throughout the community or nation as a whole. In addition to serving as an early warning sign of bio-terrorism or an epidemic, results from data analysis could assist with predicting the risk and survival analysis for patients with AIDS or others suffering from certain injuries or conditions.

Management of Customer Relations

Customer relations may be improved through healthcare data analysis, particularly for predicting specific usage patterns, preferences and needs of individuals. Such information could be applied to customer relations in various arenas, including physician offices, billing departments, call centers, inpatient and ambulatory care settings.

Additional Uses of Data Mining

The adoption of electronic health records has already allowed medical and healthcare facilities to amass large quantities of pertinent patient data. Such data can be analyzed to determine specific needs of patients based on their medical histories and current status.

Examples include alerting healthcare professionals about patients that may benefit from preventive measures, flu shots or a disease management program. Focusing on predictive analytics, providers may be able to assess the likelihood of a particular patient to adhere to his or her treatment program based on past behaviors and other pertinent factors.

Although ICD-10 continues to battle its opposition in the present, it may serve as a valuable implementation going forward. Not only could it help individual practices of facilities advance their business goals, but it could enhance the entire industry.


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