Transition to ICD-10 Could Be Convoluted, Costly, Study Finds

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The health care industry's transition to ICD-10 code sets could be costly and challenging, particularly for specialists, according to a study published in the Journal of the American Medical Informatics Association, FierceHealthIT reports (Hall, FierceHealthIT, 5/6).

About ICD-10

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 from ICD-9 to ICD-10 code sets 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 until Oct. 1, 2014 (iHealthBeat, 4/30).

About the Study

For the study, researchers from the University of Illinois-Chicago produced two mapping files based on CMS data.

The mapping files were designed to translate between ICD-9 codes and ICD-10 codes.

Findings on Code Mapping

The study found that about 60% of the ICD-9 codes translated to ICD-10 codes effectively. However, researchers also found that:

  • 36% of the ICD-9 codes were "convoluted" with entangled and non-reciprocal mappings; and
  • 1% of the ICD-9 codes had no corresponding code under ICD-10.

Researchers also analyzed codes related to certain medical specialties and found that specialists likely will be the most affected by the ICD-10 transition. For example, the study found that:

  • 60% of injury-related codes had convoluted mappings from ICD-9 to ICD-10
  • 60% of obstetrics-related codes related to had convoluted mappings;
  • 42% of infectious disease-related codes had convoluted mappings; and
  • 5% of hematology-related codes had convoluted mappings, making hematology the least-affected specialty (FierceHealthIT, 5/6).

Findings on Cost

In addition to their analysis of code mapping, the researchers conducted a case study by analyzing emergency department data from Illinois Health Connect.

After looking the annual cost for specific ED encounters, researchers found that ICD-9 codes with convoluted mapping to ICD-10 accounted for about 27% of ED costs (Murphy, EHR Intelligence, 5/6). According to the researchers, this finding suggests that the shift to ICD-10 code sets could increase the risk of costly medical errors (FierceHealthIT, 5/6).

Response to Findings

Researchers recommended that health care organizations focus their personnel training and management resources on the most frequently used and complex mappings between ICD-9 and ICD-10 codes (EHR Intelligence, 5/6).

The authors also established an online portal to help health care organizations map codes for complex diagnoses (FierceHealthIT, 5/6).

Stephen Ruehle
The Winston-Salem Journal reports of the struggles of Wake Forest Baptist Medical Center with EPIC's EHR implementation. (The largest employer in Forsyth County, NC). They've hired two consulting groups, laid-off 950 employees, eliminated incentive bonuses, eliminated retirement contributions, requested voluntary furloughs, instituted wage and hourly cuts and a hiring freeze. They've lost over $76 million in operational expenses due to implementation of EPIC. Novant Healthcare Plans to spend $600 million on EPIC and Cone Health has already lost $13 million during implementation of EPIC. With the largest healthcare facilities struggling, how can our government even consider the ICD-10 mandate in 2014? THE ICD-10 IMPLEMENTATION GUIDE, published by CMS references “failing revenue, delays, denials and rejections” (17) times, “costs and budget limitations”, (9) times, with their advice: “increase lines of credit”.
Michael Milne
The real problem here will be in the application of the codes whether there is a complete mapping or not. Going from 14,000 to 69,000 means most doctors or staff will have to know or be able to chose between hundreds of codes for similiar illnesses or procedures but with different affects. So it will be down to the person doing the coding memory of thousands of codes and their interpretation of not only the code by how the patient's affect fits it. Basically, what will happen is only the major category will be important for subsequent medical providers in the history. It will also add complexity eventually for payment as payers try to disqualify to maximize corporate profit.

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