Study: ICD-10 Transition Could Result in Data Loss for Pediatricians

June 3, 2014 in News

The transition from ICD-9 to ICD-10 code sets could result in a significant loss of payment and clinical data for pediatricians and other low-margin practices, according to a study published in the journal Pediatrics, Modern Healthcare reports (Robeznieks, Modern Healthcare, 6/2).


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 April, President Obama signed into law legislation (HR 4302) that pushes back the ICD-10 compliance date until at least October 2015.

In May, CMS confirmed that HHS plans to soon release an interim final rule that will set the new ICD-10 compliance deadline as Oct. 1, 2015 (iHealthBeat, 5/5).

Study Details

For the study, researchers at the University of Illinois identified 2,708 Medicaid ICD-9 codes used throughout the state in 2010 and matched them to pediatric primary care patients in the University of Illinois Hospital and Health Sciences System (Modern Healthcare, 6/2).

Specifically, the authors analyzed how the ICD-9 codes would translate to the new ICD-10 codes and organized them into five categories:

  • Identity, where codes are equivalent;
  • Class to subclass, where one ICD-9 code applies to multiple ICD-10 codes;
  • Subclass to class, where multiple ICD-9 codes apply to one ICD-10 code;
  • No transition, where ICD-9 code did not transition to ICD-10 code; and
  • Convoluted, where transitions were complex or difficult (Frellick, MedScape, 6/2).

Study Findings

Overall, the researchers found that 26% of translations were convoluted, representing:

  • 23% of Medicaid pediatric encounters; and
  • 16% of Medicaid reimbursements (Modern Healthcare, 6/2).

As a result, the researchers estimated that pediatricians could face up to an 8% risk of losing financial and clinical information during the transition to ICD-10 codes.

Andrew Boyd, senior author of the study, said, “From a clinician’s point of view, you are losing critical information during this transition. You need to be aware of it, especially if you’re trying to get urgent or expensive care.”

In regards to billing data losses, the authors wrote that pediatric practices “function on a thin financial margin in which 3% to 5% of codes resulting in billing errors could have a significant financial impact” (MedScape, 6/2).  

Despite the potential losses, the authors wrote that the coding transition is “likely to provide important benefits over time” (Modern Healthcare, 6/2). They recommended that pediatricians and other low-margin practices plan appropriately to avoid any financial data losses due to the coding change (MedScape, 6/2).

CMS Recommends Delaying ICD-10 Front-End Testing

In related news, CMS on Friday announced that the March ICD-10 testing period did not reveal any issues with the new claims processing by the Medicare fee-for-service system.

The testing period involved more than 127,000 claims submitted from designated testers, including health care providers, clearinghouses and others (AHA News, 6/2).

CMS recommended that stakeholders delay new front-end testing until after Oct. 6, when Medicare updates its systems. CMS said it plans to soon release information about 2015 end-to-end testing for ICD-10 (Slabodkin, Health Data Management, 6/2).

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