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Prepare for Costly Conversion to ICD-10

June 3, 2013

Preparing for ICD-10A recent study (May 2013) study published in the Journal of American Medical Informatics Association confirms the belief that the coming conversion to ICD-10 diagnosis and treatment coding is challenging to medical practitioners and other medical providers. Moving from ICD-9 codes to ICD-10 code sets and methodology is required and accommodates codes for newer diseases and treatment procedures.

ICD-10 Code Mapping

The final rule, published in August 2012, has delayed legal compliance until October 1, 2014. However the transition from around 14,000 codes to almost 69,000 codes is a major revision in the ICD-9 code sets medical personnel and billers have dealt with in the past.

While this conversion is required for all medical providers, this study confirms the prior warnings of challenges for all practitioners. The challenge goes beyond just the almost five-fold expansion in the raw number of codes necessary.

The World Health Organization (WHO), administrator of the codes, mandates diagnosis codes only. However, the US also supports codes for treatment procedures, adding to the volume of new codes. These additional codes serve to lengthen the potential learning curve for US insurance company and medical practice personnel.

The global medical community has already lobbied to change ICD-10 implementation dates, which have been extended twice to date. At this writing, it does not appear that another extension from WHO is forthcoming. Therefore, the October 2014 implementation date is firm, requiring practitioners and insurers to train and test now.

Study Results

University of Illinois-Chicago researchers conducted this study to learn the real world condition of the massive changes in code mapping in the transition from ICD-9 to ICD-10 coding. The new diseases that have appeared since the last code update only add to the conversion challenges.

Along with the cost of the conversion, the study found there is another “C” involved. Convolution. The research discovered the number of ICD-10 codes that respondents claimed were convoluted is significant. Study participants expressed confusion over the convolution factor.

The good news: Around 60 percent of ICD-9 codes directly translated to ICD-10 codes seamlessly. This should help experienced medical coders adjust to an apparent majority of conversion coding requirements. This still leaves 40 percent of new codes to be learned by personnel.

Unfortunately, the perceived convolution factor also reared up. Respondents noted that a full 36 percent of ICD-9 codes were convoluted, containing “entangled and non-reciprocal mappings.” Even one percent of ICD-9 codes “had no corresponding code under ICD-10.”

The study also indicates that some medical specialties will be highly challenged to enjoy a seamless conversion. Consider the following results.

  • Around 60 percent of injury-related codes displayed convoluted mapping issues.
  • Another 60 percent had equal convoluted code mapping confusion for obstetrics codes.
  • Over 40 percent of infectious disease codes suffered the same convolution fate.
  • Hematology escaped with only five percent code convolution, which hopefully helps this specialty make the transition successfully.

The cost issue goes beyond the budgetary effects of effective training, which may impact smaller medical practices more than larger practices and hospitals. However, the study also analyzed emergency department (ED) statistics from a cost and quality perspective.

Researchers found that up to 27 percent of ED encounters could be affected by the convoluted codes. This result troubled researchers, who believe that this result could “increase the risk of costly medical errors.” The conclusion is not surprising.

Researchers recommend that all healthcare organizations target training and management efforts on ensuring the most frequently used codes and those identified as convoluted as a top priority. The extra cost of superior training could pale in comparison to the much higher potential cost of billing errors or incorrect diagnosis codes.

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