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).
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).