The Transition to ICD-10-CM: Challenges for Pediatric Practice

Abstract

BACKGROUND AND OBJECTIVES: Diagnostic codes are used widely within health care for billing, quality assessment, and to measure clinical outcomes. The US health care system will transition to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), in October 2015. Little is known about how this transition will affect pediatric practices. The objective of this study was to examine how the transition to ICD-10-CM may result in ambiguity of clinical information and financial disruption for pediatricians. METHODS: Using a statewide data set from Illinois Medicaid specified for pediatricians, 2708 International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis codes were identified. Diagnosis codes were categorized into 1 of 5 categories: identity, class-to-subclass, subclass-to-class, convoluted, and no translation. The convoluted and high-cost diagnostic codes (n = 636) were analyzed for accuracy and categorized into “information loss,” “overlapping categories,” “inconsistent,” and “consistent.” Finally, reimbursement by Medicaid was calculated for each category. RESULTS: Twenty-six percent of pediatric diagnosis codes are convoluted, which represents 21% of Illinois Medicaid pediatric patient encounters and 16% of reimbursement. The diagnosis codes represented by information loss (3.6%), overlapping categories (3.2%), and inconsistent (1.2%) represent 8% of Medicaid pediatric reimbursement. CONCLUSIONS: The potential for financial disruption and administrative errors from 8% of reimbursement diagnosis codes necessitates special attention to these codes in preparing for the transition to ICD-10-CM for pediatric practices.

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

“…6 In contrast, family medicine mapping is slightly more complex than oncology with a convolution rate of 18%. 4 …”

“…3 Previous studies have evaluated a number of different medical specialties in regards to the transition to ICD-10-CM. 4–6 The recent ruling by Center for Medicaid and Medicare Services to not deny any claim due to lack of specificity for the first year during the transition to ICD-10-CM highlights the challenge and potential impact of the new coding system. 7 To our knowledge, no other studies have evaluated the impact ICD-10-CM will have on the practice of family medicine.…”

The complexity and challenges of the International Classification of Diseases, Ninth Revision, Clinical Modification to International Classification of Diseases, 10th Revision, Clinical Modification transition in EDs

“…Emergency departments are not alone in facing ICD-10-CM transition challenges. Prior studies indicated significant percentage of convoluted code mappings and information loss due to clinically incorrect mappings in evaluation of hematology-oncology [11] and pediatrics [12] patient accounting data. Because ICD codes are utilized for adverse effects reporting by hospitals, Patient Safety Indicators (PSI) compiled by the Agency for Healthcare Research and Quality (AHRQ) might suffer from similar challenges [13].…”

Methodological Challenges and Lessons Learned from Assessing the Routine Health Information Management Data Quality: Experience from Tanzania

“…The analysis was simpler after the initial transcription of the records, just tabulation of missing data and comparison of the registers counts with the monthly reports. The simplified version of the data quality assessment is counting from the summary tables, the proportion of reporting health facilities and the total reports submitted against the expected [12][13][14][15][16]. However, these methods leave out the recording process, which is an essential step toward quality assessment.…”