Transition to international classification of disease version 10, clinical modification: the impact on internal medicine and internal medicine subspecialties

Abstract

BackgroundThe US health care system uses diagnostic codes for billing and reimbursement as well as quality assessment and measuring clinical outcomes. The US transitioned to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) on October, 2015. Little is known about the impact of ICD-10-CM on internal medicine and medicine subspecialists.MethodsWe used a state-wide data set from Illinois Medicaid specified for Internal Medicine providers and subspecialists. A total of 3191 ICD-9-CM codes were used for 51,078 patient encounters, for a total cost of US $26,022,022 for all internal medicine. We categorized all of the ICD-9-CM codes based on the complexity of mapping to ICD-10-CM as codes with complex mapping could result in billing or administrative errors during the transition. Codes found to have complex mapping and frequently used codes (n = 295) were analyzed for clinical accuracy of mapping to ICD-10-CM. Each subspecialty was analyzed for complexity of codes used and proportion of reimbursement associated with complex codes.ResultsTwenty-five percent of internal medicine codes have convoluted mapping to ICD-10-CM, which represent 22% of Illinois Medicaid patients, and 30% of reimbursements. Rheumatology and Endocrinology had the greatest proportion of visits and reimbursement associated with complex codes. We found 14.5% of ICD-9-CM codes used by internists, when mapped to ICD-10-CM, resulted in potential clinical inaccuracies.ConclusionsWe identified that 43% of diagnostic codes evaluated and used by internists and that account for 14% of internal medicine reimbursements are associated with codes which could result in administrative errors.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3110-1) contains supplementary material, which is available to authorized users.

No Clinical Benefit to Treating Male Urinary Tract Infection Longer Than Seven Days: An Outpatient Database Study

“…To exclude visits in which antibiotics may have been prescribed for nonurinary infections, visits with any alternative indication of infection were excluded from our study population. To avoid sampling bias, we abstained from expanding our inclusion dates beyond September 30, 2015 to avoid any inconsistencies in diagnoses following the ICD-9 to ICD-10 transition (beginning October 1, 2015) as others have reported [25]. An additional strength of our study was the ability to review recurrent visits in detail to exclude follow-up visits and asymptomatic bacteriuria cases from true recurrences, adding confidence to our findings.…”

Physician code creep after the initiation of outpatient volume control program and implications for appropriate ICD-10-CM coding

“…Caskey et al further suggested that there is a potential for financial disruption due to inaccurate mappings from ICD-9-CM to ICD-10-CM [20]. For example, ICD-9-CM 272.4 "other and unspecified hyperlipidemia" could be map to either E78.5 "hyperlipidemia unspecified" or Fig.…”

“…2 Index percent (%) change of the quarterly number of visits by different coding practices among a fix patient cohort in tertiary medical centers (intervention group) and clinics (control group) before and after the proposal and implementation of the Outpatient Volume Control Program (OVCP) in Taiwan (ICD-10-CM code E119 "diabetes mellitus without complication" was a OVCP monitoring code; E110 − E118 "diabetes mellitus with complication" were non-OVCP monitoring codes) Using the number of visits of 2016Q1 as the base for % change E78.4 'Other hyperlipidemia." As indicated by the authors, the decision of which code to select may seem arbitrary but the reimbursement may differ as one code may be a higher reimbursed service by a payer despite the fact there is no intuitive difference to the billing clinician [20]. Several inpatient data studies have indicated that hospitals could improve the pneumonia mortality and readmission rate by coding respiratory failure or severe sepsis as primary diagnosis; these patients would not be included in the calculation of the pneumonia mortality and readmission rate under the Hospital Readmission Reduction Program initiated by the Centers for Medicare and Medicaid Services [14][15][16][17].…”

Frailty assessed by administrative tools and mortality in patients with pneumonia admitted to the hospital and ICU in Wales

“…Our study has limitations. The administrative in-patient data lacks detailed information about disease severity and medical treatments; comorbidities are dependent upon reliable ICD-10 coding, and variation in documentation and coding of diagnoses could contribute to measurement error 34 . However, in Wales, routinely collected population-scale EHR data are sufficiently robust and accurate to be used in research or for health services planning 35 .…”