A matrix, The Matrix, and ICD-10-PCS

The word “matrix” has lots of definitions, and three of the most common ones all describe an aspect of ICD-10-PCS (PCS for short). I know…why bother with yet another blog that starts with a dictionary definition, or worse yet, an analogy using a movie plot? This blog has both because a matrix and the Matrix are relevant not only to PCS but to the direction that health information is moving, and to our place in it.

Mathematics. In mathematics, a matrix is “a rectangular array of quantities or expressions in rows and columns that is treated as a single entity and manipulated according to particular rules.”¹

The PCS Tables are “a rectangular array of quantities” we call “PCS values.” PCS values are the text labels with their associated letter or number in each column of the PCS matrix. They are “manipulated according to particular rules” to build a valid code.

We can embrace the efficiency of a matrix representation in PCS and elsewhere in the industry. Table formats and the cognitive style that goes with them can be encouraged wherever possible in health information, so that coded data can be quickly and easily summarized, filtered and queried for repeating patterns. We as coders are in the business of producing good data for the health information transactions that require coded data. Anyone who has anything to do with medical record codes and coding can do their job better if they clearly see their job in the context of the bigger health information picture, one that includes the EHR and other representations of the medical record.

Biology. In biology, a matrix is “an environment or material in which something develops; a surrounding medium or structure.”²

The ICD-10-PCS structure is “an environment into which something develops.” PCS was not born full-grown. There is lots of room for it to grow and mature.

What will develop in the PCS matrix over the years of its life cycle will be increasingly detailed information about procedures. If used as intended, this increasingly detailed information should help the industry make better decisions about cost and quality of care.

Movies. In Hollywood, the 1999 uber-hit movie The Matrix gave us a new definition of matrix. The Urban Dictionary defines “the Matrix” as a “computer-generated dream world built to keep us under control in order to change a human being into a battery.”

PCS is one small part of the “computer-generated dream world” that we call “health information.” Although my job hasn’t “changed me into a battery” as far as I know, and it certainly hasn’t “kept me under control,” there is no question that the health information sector of the healthcare industry is a computer-generated representation of the real world of health care.

Health care is an intensely physical world, where doctors and nurses and technicians in various healthcare specialties talk to, touch and provide services to a person that alter their physical state. Health information is the cyberspace representation of those interactions taking place in the physical world. It comes in a myriad of forms: in the narrative report dictated by a physician, in the user interface of an EHR, in the various code sets from SNOMED CT to ICD to NDC (National Drug Codes).

The purpose of the health information matrix is not to provide cheap energy for an alien species, but to provide good information for our own species. How good a job are we doing? As members of the health information matrix, are we ready to “take the red pill,” and take a hard look at the representation we make of the physical world, and ask ourselves, is it timely? Is it useful? If not, how can we produce that representation faster and better?

Of course I am not suggesting we all wear black leather and shades to work, and leap around like ninjas till we have destroyed the health information matrix. But I don’t think we can “take the blue bill” and cling to the local status quo. Stuff is happening out there. The health information matrix will evolve with or without our participation, in some areas gradually and in other areas disruptively. Do we participate actively or hope we get to stay comfortable in our own corner?

Rhonda Butler is a clinical research manager with 3M Health Information Systems.

¹ Oxford Dictionary, http://www.oxforddictionaries.com/us/definition/american_english/matrix

² Merriam Webster Dictionary, http://www.merriam-webster.com/dictionary/matrix