Health Language Blog

Implications to Using Old and Outdated Codes

Posted on 05/18/16

Breaking_Chain.jpgMany were relieved after the ICD-10 implementation deadline. But, though October 1st 2015 is now long past, it does not mean the end of dealing with healthcare terminologies and the complexities set into motion for healthcare providers and payers.  

As we all know, healthcare is a constantly changing industry. New medical breakthroughs as well as newly discovered diseases lead to new treatments and innovative solutions. All of these changes must be represented in evolving medical terminologies. Terminologies, standards for treatment and care, and scientific developments are rarely set in stone. Code systems and terminology sets may be updated daily. If you and your organization cannot keep up with all of the changes, your entire organization is at risk.  

The transition to ICD-10 was a huge task that forever altered the face of healthcare data management. However, the shift to ICD-10 is just one piece of the puzzle.  No terminology set is perfect and ICD-10-CM and ICD-10-PCS are no exception. Starting on October 1st of 2016, the first of the ICD-10 updates will take place. Codes will be added, changed, and altered for these and other reasons:

  • The introduction of new medical devices
  • The addition of new diseases or conditions (Zika, for instance)
  • A need for greater specificity in certain categories of codes
  • The introduction of codes for new procedures
  • Introduction of codes for new drug therapies

SNOMED CT, LOINC, and other terminologies will likewise continue to undergo yearly updates to help them stay relevant with the changing landscape of healthcare.

Staying on top of these updates and not falling into the trap of using old and outdated codes is important for both payers and providers. But the manpower to do this is daunting. Keeping up with and tracking the updates to all your relevant code sets can cost time and money, and cause frustration.

Why Using Up-to-Date Codes Matters for Payers

As a payer, ideally you are facilitating a seamless billing relationship with your providers. If you are denying claims due to processing of invalid codes, there will be many headaches and lost hours. This was certainly true in the wake of the ICD-10 conversion, but it will also be true moving into the future. Current and correct codes in all your terminology sets assure proper and timely processing of claims. This will reduce your denial rate.  With the correct information in your systems, claims will move effortlessly through your processing and prevent lost work hours due to unnecessary errors.

Why Using Up-to-Date Codes Matters for Providers

For providers, reporting quality measures plays a large role in participation in accountable care arrangements. Using invalid and outdated codes and not properly reporting patient encounters causes increased work hours to deal with problems, and can cause your facility to lose eligibility for participation in these important programs. Finally, missing benchmarks due to invalid codes can prevent eligibility for pay-for-performance programs that offer your facility valuable financial incentives based on performance. Keeping your working terminologies up-to-date will prevent your patients and clinicians from losing out on many important incentives. 

What Can You Do?

While managing numerous updates for different terminologies may seem complex, you can find the key to maintaining these updates with an Enterprise Terminology Management Solution. Enterprise Terminology Management enables the creation of a single, integrated, and trusted source of terminology truth across an enterprise. Whether you are a payer or a provider, a quality Enterprise Terminology Management solution will allow you to stay up-to-date on all your terminology sets without having to juggle numerous ongoing terminology updates. Best of all, it will prevent your taking time away from patient care to undertake laborious terminology projects.

By implementing an effective Enterprise Terminology Management system, you can make sure that the reporting you do always accurately reflects the quality care you provide.

How do you plan to manage your terminology updates?  Let us know in a comment below.


For more information on the recent updates coming to ICD-10, read our past 5,500 Updates Are Coming to ICD-10 blog post.

enterprise terminology management

Topics: ICD-10, terminology, enterprise terminology management

About the Author

Katie Sutton

Katie Sutton Clinical Informatics Manager for Health Language, brings 11 years of medical coding experience to the HL Content team. Katie started her healthcare career as a Medicare billing specialist and outpatient coder at the University of Colorado Hospital. She moved to The Children’s Hospital of Colorado as an Inpatient and Outpatient facility coder, and capped her coding career as an outpatient coder for Centura Health. Katie has coded across multiple specialties and is happy to have such a wide range of coding knowledge from the wonderful institutions where she has worked. She loves medical terminology and is always excited to teach others and help them on their own journey.