The coming switch to ICD-10
this fall could spell data and financial losses that could “evaporate the operating margin of a practice,” even in a medical specialty with a less code-intensive transition, according to a team of researchers from the University of Illinois at Chicago.
The changeover also could mean provider problems with issues ranging from short-term staffing
management to multi-year quality improvement reporting, researchers said.
Under an HHS mandate, the healthcare industry must switch from the ICD-9 family of disease classifications in current use to the far larger and more complex ICD-10 codes on Oct. 1. The ICD-10-CM (clinical modification) includes more than 68,000 diagnostic codes, compared with about 14,600 codes in ICD-9-CM.
A report on the UIC researchers' investigation of the conversion, Identifying Clinically Disruptive (ICD-10) Clinical Modification Conversions to Mitigate Financial Costs Using an Online Tool
, is scheduled to appear in the March issue of the Journal of Oncology Practice and was published online last month.
UIC researchers specifically analyzed the impact of the ICD-10 conversion on hematology-oncology coding because earlier UIC research indicated that the specialty's transition to ICD-10 would be simpler than that of many other medical specialties.
For each of the hematology-oncology codes examined, UIC researchers looked at whether the translation from ICD-9 to ICD-10 would produce a loss of clinical information and whether such a loss had financial implications, according to a UIC news release
The team determined that “the transition from ICD-9 to ICD-10 led to significant information loss, affecting about 8% of the Medicaid codes and 1% of the codes in our cancer clinic,” said Dr. Neeta Venepalli, UIC assistant professor of hematology/oncology and the lead author of the new study.
Additionally, 39 ICD-9-CM codes that lost information accounted for 2.9% of total Medicaid reimbursements at the university's cancer center. Hypothetical costs associated with lost information totaled $479,299, “accounting for 5.9% of billing for 100 codes evaluated and 5.3% of billing charges for all 704 hematology-oncology diagnosis codes,” the report said. “We think that these codes and this amount of money are potentially at risk,” Venepalli said in an interview.
Providers may be at a conversion disadvantage because CMS Medicare contractors will be using CMS' general equivalent mapping, or GEM, code translation system, but GEM is “relatively inaccessible to most providers, researchers, managers and payers without coding expertise and additional ICD-10-CM coding manuals,” the study authors said. Private insurance companies may have their own cross-mapping systems.
The coding switchover will also affect long-range planning for everything from supply chain management to quality improvement, according to Dr. Andrew Boyd, UIC assistant professor in biomedical and health information sciences and a study coauthor. Healthcare planners will need to work with historical data from ICD-9 codes as well as integrating new data with ICD-10 codes.
“We have decades of data on how we manage these things,” Boyd said. “For analytics, you compare up to a five-year moving average. If you look at the Swiss conversion (to ICD-10), it took them 5 years to get to the same quality of data as ICD-9.”
In their latest research, the UIC team looked at 2010 Illinois Medicaid data to identify 120 ICD-9-CM outpatient codes and reimbursements used by hematology-oncology physicians with the highest reimbursement. They also looked at UIC physicians' 100 most-used outpatient diagnoses codes and billing charges from 2010 through 2012, running the selected codes through a publicly available analysis tool called the Motif web portal
. The tool was developed at UIC to translate ICD-9 codes into ICD-10 codes and to predict bi-directional cross mappings that could be problematic.
This latest study is a more narrowly focused re-examination of ground covered by a broader research effort reported last year
by Boyd and other UIC researchers, using the web-based ICD conversion tool.
In the earlier study, researchers looked at the records of slightly more than 24,000 patient visits to 217 emergency departments and checked their coding for ICD-9 and ICD-10. They found that 37% of the codes and 27% of the costs linked to those ED visits were associated with “convoluted” diagnoses.
By “convoluted” Boyd said that definitions are non-reciprocal between the code sets and the different concepts “get intertwined” in such a way that they cannot be sorted and easily reorganized after the switch to ICD-10.
“If you wanted to make a comparison between Sept. 2014 and Oct. 2014, the convoluted codes will get you different answers,” Boyd said. “When you want to compare month-to-month, year-over-year, the convoluted ones require physicians to sit there and interpret the mappings—otherwise your data value will decrease.” Follow Joseph Conn on Twitter: @MHJConn