# Presentation: 522772

## Coding New Technology:Challenges and Opportunities

*ICD-9-CM Coordination and Maintenance Committee November 1-2, 2001*
*John D. Shaw, President*

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## Dilemma: Irresistible Force Meets Immovable Object

- _Irresistible Force of New Technology_
- Rapid Development – Min. Invasive, Bio-tech
- 5 Year Patient Wait After FDA is Unacceptable
- Congress Linked Payment to New ICD-9 codes
- _Immovable Object of ICD-9-CM Structure_
- Few Codes Left, Several Years Until ICD-10
- Coding Structure Not Designed for This
- Need to Maintain Integrity & Consistency of I-9

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## De-Couple Data from Dollars

- For R-word/P-word, Congress made a new ICD-9 Code _**Necessary, but NOT Sufficient**_
- Let’s collect data for better downstream decisions
- AND for OTHER Uses and Users of ICD-9 Data:
- Quality/Outcomes Measurement/Monitoring
- Systems Improvement Studies
- Effectiveness Evaluations of Systems & Technology
- Epidemiology, Public Health, Healthy People 2010
- Evidence-Based Decision Making

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## Concept Discussion:Three Decision Steps (In Order)

_**1. Process:**_  SHOULD a Code Set structure with one or more flag code(s) be used to generate more room and faster publication of Guidance?
- (Only answer # 2 and # 3 IF answer to # 1 is YES)
_**2. Location:**_  WHERE should flag code(s) be:
- Volume 1-2 (e.g.V-zero) or Volume 3 (e.g.Chapter zero)
_**3. Content:**_  HOW should Flag codes be WORDED?

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## Option 1: We Could Do Nothing More Now

- We could continue to do the best we can with available room and Chapters 0 and 17 until ICD-10 is implemented
- We could hope that manufacturers stop inventing technology (Or at least slow down)
- We could wait until Congress tells us specifically what to do and how to do it________________________________________________________________________________________________
- OR We can develop our own “New Technology”

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## “Outside the Box” Solutions:Make Room vs. Find Room

- “Code Sets” consisting of:  new “Flag” Code(s)
- Combined with one or more existing/new codes
- _Together_ describing the New Technology
- One Procedure code can then represent BOTH:
- the Old technology (without the flag code) and
- the New technology(With the flag code)
- E.g. Stent PLUS Flag code=Drug-eluting Stent
- 36.06 plus Flag code = Drug-eluting Coronary Artery Stent
- 39.50 plus same Flag code = Drug-eluting non-CA Stent
- When/if Drug-eluting becomes standard practice, drop flag

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## BOTH Stable and Responsive

_**Stable:**_ Systems Updates on Annual Basis –(Meeting Provider and Payor System Needs):
- Publish for Books and Grouper/Pricer Software
- Include Flag Codes so they are in Data Edits
- Any R-word/P-word use on current annual cycle
_**Responsive:**_ Implement New Technology Through Coding Guidance for Use of Flag Codes –(Meeting Patient and Congressional Needs):
- Quarterly (Coding Clinic, EAB) or
- Semi-Annual (post C&M meeting)

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## Concern: How Easy for Coders to Find Technology Code

- Only Coders in Hospitals Using New Technology Need to Find it to Code it
- MUST Code New Technology Somewhere
- Introduction of Technology and need to code is NOT Leisurely – Coding Clinic & EAB regardless
- Manufacturers will insure clients have guidelines
- Coders in Hospitals Without New Technology
- Will they care how above hospitals find codes?

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## IF We Want Flag Codes, WHERE Do We Put Them?

_**Vol. 1&2 - V-code**_
- _Advantages_
- More Room in codes
- More Room on bill
- _Disadvantages_
- Mix of Dx and Pr
- External (WHO) Structure Restrictions

_**Vol. 3 – Chapter Zero**_
- _Advantages_
- All PR codes in Vol. 3
- Less Structure Constraint
- _Disadvantages_
- Less Room in codes
- Less Room on bill

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## Content Considerations:How to WORD Flag Codes

- Could be Considered Interim Use
- Trade off:
- Better Guess at Pipeline ->More Responsive
- Worse Guess at Pipeline ->”Wasted” Codes
- Single Flag Code
- Numeric Succession (1st Use, 2nd Use, etc.)
- Flag Codes by Body System
- Flag Codes by Approach
- Hybrid

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