Business Case
The Centers for Medicare and Medicaid Services (CMS) mandated a major change in its diagnostic coding scheme, effective October 1, 2015. The change required a conversion from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code set to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and Procedure Coding System (ICD-10-PCS) code sets.
Key aspects of this change included an increase in the number of diagnostic codes available (from approximately 17,000 to 155,000 discrete codes), as well as modifications in to the coding structure itself. As was the case with all HIPAA covered entities, NYS required a full analysis of policies, procedures and information systems affected by this change. In turn, the MDW needed to be configured to accurately capture and report clinical diagnostic data being used for reimbursement, quality assessment, benchmarking, research, public health reporting and strategic planning purposes.
The Solution
CMA was tasked with orchestrating the following changes, in order to successfully implement ICD-10 for the state of New York:
- Expand all applicable fields on source data feeds and incoming data, in order to accommodate the new ICD-10 Diagnosis and Procedure codes.
- Modify all claim and dimensional tables within the NYS MDW, in order to handle the new ICD-10 Diagnosis and Procedure codes.
- Modify all current NYS MDW ETL and data delivery processes, in order to process the new ICD-10 Diagnosis and Procedure codes. Logic was modified to support both ICD-10 and ICD-9 codes.
- Modify all NYS MDW Business Intelligence (BI) Claim Business Areas (Claims, Netted Claims, Denied Claims, Prior Approval, e-Commerce) and Reports impacted by the implementation of new ICD-10 Diagnosis and Procedure codes.
- Update Data Warehouse Assistant eQueries, OBIEE catalog queries for Claim and non-Claim data, Power user SQL’s for Claim and non-claim data that were impacted by the implementation of ICD-10 Diagnosis and Procedure codes.
- Accept, store, and process the new ICD-10 Diagnosis and Procedure codes.
The Results
The NYS MDW met CMS’s deadline to implement the new ICD-10 code sets. CMA’s phased implementation approach ensured the project was successfully completed on schedule with minimal issues encountered.