Guest post: Implications of population health directives for inpatient coding and CDI

by Adriane Martin, DO, FACOS, CCDS

Coding and CDI professionals who skimmed through the fiscal year 2020 IPPS proposed rule may have noticed that quite a few longstanding CCs and MCCs are poised for removal effective October 1.

What may have quietly slipped past their attention was the proposed addition of the ICD-10-CM code for homelessness to the CC list. The proposed addition of this health status code to the list is a step in the right direction for health systems looking to improve the overall wellbeing of their patients through population health directives.

Population health is broadly defined as interrelated conditions and factors that influence the health of groups of people. These factors are known as social determinants of health and may include education level, food stability, job stability, and living conditions. Population health initiatives can take the form of managing a group of people with a diagnosis of congestive heart failure or managing the health of people living in Small Town, USA.

Considerations for inpatient CDI

ICD-10-CM code Z59.0 for homelessness has been proposed to be added to the CC list. Why? Unsanitary living conditions, inadequate food for nutrition, and a lack of money to buy necessary medications are issues faced by people without stable living situations. These factors increase the risk of patient complications, readmissions, and mortality.

Capturing homelessness through claims-based data allows hospitals to more accurately report costs of care and expected outcomes. A hospital’s observed outcomes can be compared to their expected outcomes to determine what internal processes can be improved. The impact of quality performance on reimbursement will continue to grow as the industry moves toward the goal of measurable quality care delivery.

Traditionally, inpatient CDI programs have been concerned with ensuring optimization of the MS-DRG severity of illness and risk of mortality scores for single episodes of care. To thrive in the brave new world of population health, CDI professionals must expand their focus to include those diseases and conditions that have not traditionally been an area of interest due to their lack of impact on MS-DRG severity of illness and risk of mortality scores.

Editor’s note: This article originally appeared in JustCoding. Dr. Martin is vice president of Enjoin in Eads, Tennessee. She has provided clinical insight and education as part of the pre-bill review process since 2014. She is board-certified in general surgery, assists with documentation improvement, and provides specialty-to-specialty physician education in areas related to ICD-10, with a focus on surgical procedures and ICD-10-PCS. Opinions expressed are that of the author and do not necessarily represent HCPro, ACDIS, or any of its subsidiaries.