Simulation of ICD-9 to ICD-10-CM Transition for Family Medicine: Simple or Convoluted?

Abstract

Objectives The objective of this study was to examine the impact of the transition from International Classification of Disease Version Nine Clinical Modification (ICD-9-CM) to Interactional Classification of Disease Version Ten Clinical Modification (ICD-10-CM) on family medicine and identify areas where additional training might be required. Methods Family medicine ICD-9-CM codes were obtained from an Illinois Medicaid data set (113,000 patient visits and $5.5 million dollars in claims). Using the science of networks we evaluated each ICD-9-CM code used by family medicine physicians to determine if the transition was simple or convoluted.1 A simple translation is defined as one ICD-9-CM code mapping to one ICD-10-CM code or one ICD-9-CM code mapping to multiple ICD-10-CM codes. A convoluted transition is where the transitions between coding systems is non-reciprocal and complex with multiple codes where definitions become intertwined. Three family medicine physicians evaluated the most frequently encountered complex mappings for clinical accuracy. Results Of the 1635 diagnosis codes used by the family medicine physicians, 70% of the codes were categorized as simple, 27% of the diagnosis codes were convoluted and 3% were found to have no mapping. For the visits, 75%, 24%, and 1% corresponded with simple, convoluted, and no mapping, respectively. Payment for submitted claims were similarly aligned. Of the frequently encountered convoluted codes, 3 diagnosis codes were clinically incorrect, but they represent only < 0.1% of the overall diagnosis codes. Conclusions The transition to ICD-10-CM is simple for 70% or more of diagnosis codes, visits, and reimbursement for a family medicine physician. However, some frequently used codes for disease management are convoluted and incorrect, where additional resources need to be invested to ensure a successful transition to ICD-10-CM.

Mapping from the International Classification of Diseases (ICD) 9th to 10th Revision for Research in Biologics and Biosimilars Using Administrative Healthcare Data

“…32,35 Some categorized the complex relationships between ICD-9 and ICD-10 codes into different patterns. 12,15,16,[18][19][20][21]40 Boyd et al developed a categorization system of five groups (i.e., "identity," "class-to-subclass," "subclassto-class," "convoluted," and "no mapping") and reported the percentage of ICD-9 codes falling into each category. 12,15,16,[18][19][20][21] For ICD-9…”

“…14,22,24,25,27,[29][30][31] Others developed bidirectional or more complicated networks of links to identify ICD-10 codes (e.g., forward backward mapping, mapping motifs, etc). [12][13][14][15][16][17][18][19][20][21][23][24][25][26]30,31 Given the much larger number of available codes in the ICD-10 system, which could lead to a spurious variation in the outcome occurrence or covariate distributions, it is imperative to determine the performance of ICD-9 to ICD-10 mapping methods in a real-world data setting.…”

“…The implementation of the new ICD‐10 coding system created a challenge in analyzing data after the transition, as ICD‐10 and ICD‐9 codes do not always correspond to each other in a one‐to‐one fashion . Among various ways of ICD‐9 to ICD‐10 mapping described in the literature, the methods derived from the General Equivalence Mappings (GEMs) developed by CMS are most commonly used . Separate GEMs have been created for diagnostic and procedure codes, and each type of GEMs consists of two files, one for forward mapping (i.e., ICD‐9 codes are mapped to ICD‐10 codes) and the other for backward mapping (i.e., ICD‐10 codes are mapped to ICD‐9 codes) .…”

“…Some studies directly used the unidirectional links between ICD‐9 and ICD‐10 codes in GEMs, such as simple forward mapping (SFM) and simple backward mapping (SBM) . Others developed bidirectional or more complicated networks of links to identify ICD‐10 codes (e.g., forward backward mapping, mapping motifs, etc) …”

Family Medicine Research That Provides Compelling, Urgent Data to Improve Patient Care

“…Yet, these same readers are unlikely to know how well they are doing, because reimbursement rates have not yet been well tested. Boyd and coauthors 6 provide a great service by estimating the inherent coding difficulties embedded in the change from International Classification of Diseases, 9th Revision (ICD-9), to ICD-10. About a quarter of the diagnosis code transitions from ICD-9 to ICD-10 were found to be convoluted, and a third of the payments were convolutedexactly what many physicians fear.…”