The Case for MDM-based Enterprise Codeset Repositories …

By John Wollman, Executive Vice President, HighPoint Solutions, www.highpoint-solutions.com

Over the next two years, leading up to the ICD-10 “go live” date of October 1, 2014, there will be many procurement cycles for ICD-10 mapping and crosswalk tools. At present, we are seeing an evolution in the philosophy relating to the management of codes and mappings that will influence buyer decisions on the types of tools to incorporate into an ICD-10 program.

In considering mapping and crosswalk tools, leading companies are viewing the problem from an ongoing operational perspective, and not simply through a transition/conversion lens. The notion is that the complexity of ICD-10 is not limited to a one-time transition or conversion. Rather, the complexity will continue to be a problem well after October 1, 2014. The ongoing operational requirements call more for Master Data Management (MDM) approaches to managing codesets, mappings and the enterprise artifacts that are comprised of codes.

Some reasons for this:

  • The number of codes, and code volatility: between the ICD–9 and ICD–10 codesets, there are roughly 160,000 codes, and they are far from static. Consider the 2012 updates (which were made during a period of a “code freeze”): this annual update contained about 4,800 adds/deletes/changes to codes and several thousand mapping changes.  We can expect volatility for the next several years.

Managing the adoption of these changes requires a lot of work, including:

  • Analyzing the impact of changes/deletions
  • Determining how to fully attribute the new codes with other identifiers
  • Mapping/relating the new codes to other enterprise artifacts (benefit tables, code lists, charge masters, medical policies, etc.)
  • Notifying the “owners” of these artifacts about the change
  • Flowing the changes to downstream systems and processes

Most crosswalk and mapping tools will help with ingesting the changes and analyzing the impacts to mappings, but they will not help with these other analysis tasks, which is a significant challenge without some type of tooling.

  • Codes don’t exist in a vacuum:  ICD codes, in most healthcare organizations, are incorporated in many artifacts that are used by lots of processes and systems (both transactional and analytical).  ICD-9/ICD-10 codes are often found in lists (used to represent aggregations of codes, such as “all diabetes codes”, etc.), benefit tables (indicating which codes are payable, under various circumstances), medical policies (identifying which procedures are applicable for which diagnoses, etc.), charge masters, DRG lists, etc.
  • ICD-9/ICD-10 Codes aren’t the only codes worth managing: Code-containing artifacts such as medical policies are expressed by more codes than ICD codes. They tend to require other types of codes such as CPT and HCPCS codes to be related to them and to the ICD-9/ICD-10 codes.

Simply storing and managing ICD-9/ICD-10 codes and GEMS/Reimbursement mappings and value-added mappings are necessary, but not sufficient to ongoing operations within a healthcare entity.  We believe that it is imperative to centrally manage these codes in conjunction with other types of codes and relate them to other artifacts (beyond mappings) that will be consumed by downstream processes and systems.  Master Data Management is the ideal enabling technology for these purposes.

We see our more progressive clients implementing master data management environments to handle mapping and crosswalk transition needs and also to address the ongoing operational requirements to adopt code/mapping updates and relate the ICD codes to other codes and artifacts. These solutions have been labeled “enterprise codeset repositories” or “encyclopedias” and are being established as centralized, governed, enterprise storage points for codes (ICD, HCPCS, DRG, CPT, etc.) mappings and other key artifacts that are comprised of codes.

The Informatica MDM Hub has the requisite object and relationship management capabilities (in the industry leading hierarchy management capabilities) to support the dynamic nature of the healthcare ecosystem and ICD-10 programs in particular.

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