How Stratsan’s Data Process has Adapted to Maintain Data Integrity
By Megan Reeves
New ICD and DRG codes are created every year by CMS. Why and how these codes are created and released is discussed in detail in this post. These diagnosis and procedure codes allow for:
- Easy storage, retrieval, and analysis of health information for evidence-based decision-making
- Sharing and comparing health information between hospitals, regions, settings, and countries
- Data comparisons in the same location across different time periods
They are usually released in the fall, with an announcement at the beginning of Q3. This allows healthcare providers to prepare and plan for any changes to come. Codes then typically go into effect October 1, the beginning of Q4 of that year.
While there is a standard schedule and process for when and how codes are released, COVID-19 is a unique situation and has triggered the creation of new codes outside the normal process. Creating a new set of codes outside the standard way of doing so, can lead to issues. In this post, we’ll discuss one such issue that our team has noticed—the spike in invalid and ungroupable DRGs—and how we’re addressing this problem for our clients.
When a new IDC Diagnosis code is created, it must be added to the allowable codes taken into consideration for a DRG grouper. A DRG grouper takes into account multiple fields on a claim, including diagnosis codes, procedure codes, patient age, discharge status, and more. If the DRG grouper isn’t updated, that code won’t be grouped properly and will come through in the data as a DRG 998 or 999, invalid or ungroupable.
What we are finding in the data we’re receiving from clients across the country is that the new COVID codes often have not been added to DRG grouper allowable codes. This means they’re disrupting the way groupers are working. This is evidenced by the very large spikes in DRGs 998 and 999 we’re seeing.
Why does this matter? Who cares?
These coding issues can make strategic planning challenging. These codes are how we normalize the reporting of what’s happening in healthcare. They enable us to make evidence-based decisions and plans for the future. They also help us identify trends and changes in health around the world.
When groupers are not updated, we see disproportionate upticks in ungroupable claims where they would otherwise be grouped into product lines, like Pulmonology, Nephrology, or Cardiology. Many of our partner's set strategies based on product lines, so these groupings are of high importance.
The Stratasan and Star Difference
When Stratasan started this year’s QA of the data we collected through our association partnerships, we noticed the spike in invalid and ungroupable DRGs. As we investigated further, we found COVID to be the cause. To address it, we worked with our DRG grouping partner, nThrive, to update the grouper outside the regular cadence. When that was complete, we reprocessed the data and found a more expected distribution of codes.
If your data vendor isn’t doing this, they should be. Data vendors must remain flexible to address the special needs of today’s healthcare space and the unique issues related to codes and code groupings.
Moreover, as we think about specifying COVID codes, it is important that your data partners provide claim-level access in order to identify these codes in the data. Flexibility is key here; being able to group the codes effectively is one thing while being able to segment data by particular COVID diagnosis codes is another. To address this, Stratasan has created a COVID flag within our curated datasets whereby users can pull data and see which cases have COVID-related codes attached to them. Users can access the data at the diagnosis code, DRG code, or full claim level, in each case applying that COVID flag.
As we continue through the pandemic, we expect more off-schedule codes will be created. Just recently we’ve started to see codes specific to doses of the COVID vaccine, even specific to the type, like Moderna or Pfizer. We expect the need for flexibility to remain an important part of the data process until we’re able to get back to that predictable schedule.
Stratasan is aware of and actively addressing these issues. We release data faster than many of our competitors, so we’re able to get in front of issues like this quickly. We’re also committed to data quality and integrity, which has led us to require a grouper update on our end prior to releasing data and to be creative in the ways we equip our users with the necessary components to understand where COVID cases exist in the data.
If your data vendor isn’t on top of this issue, and you’re in need of a partner who is, then let’s talk. Schedule time with one of our experts to learn more about Stratasan’s data process, our commitment to data accuracy, and how we can better support your strategic growth needs.
Article by Megan Reeves, VP of Strategic Partnerships for Stratasan