Study: ICD-10 Transition Could Pose Problems for Hospital EDs

May 29, 2015 in News

The challenges in mapping ICD-9 to ICD-10 code sets could negatively affect clinical workflow and finances at hospital emergency departments, according to a study published in the American Journal of Emergency Medicine, FierceHealthIT reports (Dvorak, FierceHealthIT, 5/27).

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 by Oct. 1.

Study Details

For the study, researchers from the University of Illinois at Chicago analyzed a subset of a 2010 Illinois Medicaid database of ED ICD-9 codes in an effort to determine the accuracy of current mapping tools and better prepare ED providers for the upcoming transition (Gruessner, EHR Intelligence, 5/29).

The study was funded by the University of Illinois at Chicago Center for Clinical and Translational Sciences and Institute for Translational Health Informatics and the Office of the Vice President for Health Affairs of the University of Illinois Hospital and Health Sciences System.

Study Findings

The researchers found that 27% of the 1,830 ICD-9 codes evaluated had convoluted mappings that could result in problems with reporting or reimbursement (Slabodkin, Health Data Management, 5/28).

A secondary analysis was conducted on 622 of the convoluted codes with a high visit count for clinical accuracy. The study found that 23% were clinically inaccurate, representing 8% of the total 1,830 codes examined (Krive et al., American Journal of Emergency Medicine, May 2015).

The researcher wrote,”[A]lthough CMS provides forward and backward mappings between ICD-9-CM and ICD-10-CM classifications, many codes share complex reciprocal relationships that may lead to confusion and incorrect coding.” They added, “This issue has potential to be exacerbated by the fact that a significant percentage of the billed codes are highly complex, pointing to the problem of ICD-10-CM conversion complexity and the increased number of clinically incorrect codes used under the ICD-10-CM classification” (Health Data Management, 5/28).

In addition, the researchers wrote that independent physician groups that staff EDs and perform their own billing are more likely to be overwhelmed by the amount of analysis and challenges the ICD-10 conversion poses (FierceHealthIT, 5/27).

The researchers concluded, “These challenges, if not addressed, may carry significant cost and workflow issues that will be shared by providers and payers alike.” The authors created a tool available at no-cost that allows users to receive a report on ICD-9 to ICD-10 code mappings (American Journal of Emergency Medicine, May 2015).

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