ICD-10 Transition Could Lead to Data, Financial Losses for Providers

March 17, 2014 in News

Transitioning from ICD-9 to ICD-10 code sets could lead to data and financial losses for providers, according to a study published in the Journal of Oncology Practice, FierceHealthcare reports (Sullivan, FierceHealthcare, 3/13).

Background

U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures. The switch means that health care providers and insurers will have to change out about 14,000 codes for about 69,000 codes.

In August 2012, HHS released a final rule that officially delayed the ICD-10 compliance date from Oct. 1, 2013, to Oct. 1, 2014, partially to look at the incremental changes needed in reforming health care (iHealthBeat, 3/12).

Study Details

For the study, researchers at the University of Illinois at Chicago looked at 2010 ICD-9 data from:

  • The Illinois Department of Medicaid; and
  • The University of Illinois Cancer Center.

They used 120 hematology-oncology diagnosis codes with the largest reimbursement to map the loss of clinical data from the ICD-9 format to ICD-10 (FierceHealthcare, 3/13). They also examined the 100 most-used outpatient diagnoses codes and billing charges by University of Illinois physicians from 2010 to 2012.

Study Findings

The study found that transitioning from ICD-9 codes to ICD-10 codes led to a significant loss of data.

Specifically, the transition affected about:

  • 8% of state Medicaid codes; and
  • 1% of codes in the University of Illinois cancer center.

According to the study, potential costs associated with the information loss totaled $479,299, which accounted for:

  • 5.9% of billing charges for 100 codes evaluated; and
  • 5.3% of billing charges for all 704 hematology-oncology codes (Conn, Modern Healthcare, 3/13).
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