Note from the ACDIS Interim Director: Why we are really here

by Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC

I have spent the last two days deeply immersed in the fiscal year (FY) 2024 Inpatient Prospective Payment System (IPPS) final rule. That means 2,144 pages of regulatory gobbledygook. I have taken notes about new DRGs, new codes, deletions in codes, OR and non-OR procedures, etc., that I don’t plan to get into the details of today. There weren’t any huge changes, nothing groundbreaking or completely surprising.

To be honest, I do not enjoy this annual dive into the minds of CMS, as it always seems so detached from the patient in the bed or the caregivers working to meet their needs. But this year was different in that regard. There was a constant theme woven throughout those 2,000 pages that was first mentioned on page 22. The Z59.0- codes related to homelessness were changed from a non-CC to a complication or comorbidity (CC) and that’s exciting to me.

Please understand, I am not excited that we have another opportunity to impact DRG assignment, but I am excited that we are now seeing recognition that social determinants of health (SDOH) impact a patient’s health status. CMS now recognizes homelessness as an indicator of increased resource utilization in the acute inpatient hospital setting.

ACDIS has been teaching about SDOH in our educational offerings and publications for years. We have encouraged our ACDIS members to work to obtain this information and apply the appropriate codes to support and provide data related to the increased need of these patients. Reliable data in healthcare is important. It can assist in identifying areas of need and allowing for proper resource allocation. It can be used to evaluate the effectiveness of treatment protocols and social programs. Data can help us meet the healthcare needs of our patients.

The work that CDI and coding professionals do every day, to ensure accurate capture of the population’s disease burden and needs, supports the reliability of that data.

On page 22, the final rule stated:

Consistent with the Administration’s goal of advancing health equity for all, including members of historically underserved and under-resourced communities, as described in the President’s January 20, 2021 Executive Order 13985 on: Advancing Racial Equity and Support for the Underserved Communities through the Federal Government we also continue to be interested in receiving feedback on how we might otherwise foster the documentation and reporting of the diagnosis codes describing social and economic circumstances to more accurately reflect each health care encounter and improve reliability and validity of the coded data including in support of efforts to advance health equity.

This statement again reinforces the importance of our work. Inequities in healthcare were most apparent during the COVID-19 pandemic.

In our daily work, we focus on diagnosis capture supporting DRG assignment and risk adjustment. We identify how diagnoses will impact quality measure reporting and organizational standing. This is all a very important endeavor. I also encourage you to think about the principal use of the International Classification of Diseases. The World Health Organization states on their website:

The ICD serves a broad range of uses globally and provides critical knowledge on the extent, causes and consequences of human disease and death worldwide via data that is reported and coded with the ICD. Clinical terms coded with ICD are the main basis for health recording and statistics on disease in primary, secondary, and tertiary care, as well as on cause of death certificates. These data and statistics support payment systems, service planning, administration of quality and safety, and health services research. Diagnostic guidance linked to categories of ICD also standardizes data collection and enables large scale research.

Our work is important. We should be proud of that.

Editor’s note: Prescott is the interim director of ACDIS and the CDI education director for HCPro and ACDIS. Contact her at lprescott@acdis.org.