Impact of ICD-9-CM to ICD-10-CM coding transition on trauma hospitalization trends among young adults in 12 states

Abstract

Background We aimed to estimate the impact of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding transition on traumatic injury-related hospitalization trends among young adults across a geographically and demographically diverse group of U.S. states. Methods Interrupted time series analyses were conducted using statewide inpatient databases from 12 states and including traumatic injury-related hospitalizations in adults aged 19–44 years in 2011–2017. Segmented regression models were used to estimate the impact of the October 2015 coding transition on external cause of injury (ECOI) completeness (percentage of hospitalizations with a documented ECOI code) and on population-level rates of injury-related hospitalizations by nature, intent, mechanism, and severity of injury. Results The transition to ICD-10-CM was associated with a drop in ECOI completion in the transition month (− 3.7%; P < .0001), but there was no significant change in the positive trend in ECOI completion from the pre- to post-transition periods. There were significant increases post-transition in the measured rates of hospitalization for traumatic brain injury (TBI), unintentional injury, mild injury (injury severity score (ISS) < 9), and injuries caused by drowning, firearms, machinery, other pedestrian, suffocation, and unspecified mechanism. Conversely, there were significant decreases in October 2015 in the rates of hospitalization for assault, injuries of undetermined intent, injuries of moderate severity (ISS 9–15), and injuries caused by fire/burn, other pedal cyclist, other transportation, natural/environmental, and other specified mechanism. A significant increase in the percentage of hospitalizations classified as resulting from severe injury (ISS > 15) was observed when the general equivalence mapping maximum severity method for converting ICD-10-CM codes to ICD-9-CM codes was used. State-specific results for the outcomes of ECOI completion and TBI-related hospitalization rates are provided in an online supplement. Conclusions The U.S. transition from ICD-9-CM to ICD-10-CM coding led to a significant decrease in ECOI completion and several significant changes in measured rates of injury-related hospitalizations by injury intent, mechanism, nature, and severity. The results of this study can inform the design and analysis of future traumatic injury-related health services research studies that use both ICD-9-CM and ICD-10-CM coded data. Level of evidence II (Interrupted Time Series)

Association of the Affordable Care Act Medicaid Expansion with Trauma Outcomes and Access to Rehabilitation among Young Adults: Findings Overall, by Race and Ethnicity, and Community Income Level

“…To evaluate and minimize this, we previously conducted a study examining the impact of the coding transition on trends in trauma admissions among young adults by injury mechanism, type, and severity, and the results of that study informed our selection of covariates for the current study. 41 Another limitation of this study was the fact that, because patient identification numbers in the databases used are state-specific, information on readmissions and return ED visits that occurred in states other than the state in which the patient was originally hospitalized was not available. Finally, this study included only 10 states.…”

“…We chose to use the General Equivalence Mapping minimum severity method for converting ICD-10-CM codes to ICD-9-CM codes because this strategy resulted in minimal disruption in trends across the coding transition. 41 Mechanism of injury was defined by mapping diagnosis codes into categories according to the frameworks recommended by the CDC. 42 – 44 Hospital characteristics, such as trauma center status and level, were not able to be considered because hospital identifiers that could be used for linkage to other databases with such characteristics were not available for Georgia, Kansas, or Missouri.…”

Impact of Medicaid expansion on young adult firearm and motor vehicle crash trauma patients

“…The concern about data misclassification is perhaps magnified by the fact that the study period overlaps with the ICD-9-CM to ICD-10-CM coding system transition. To minimize the effects of this transition, we previously conducted a study that examined its impact on trends in traumatic injury–related hospitalizations among young adults by injury mechanism, type, and severity, and the results of that study informed our selection and definition of covariates in the present study [ 41 ]. The prevalence of many injury types was affected by the coding transition.…”

“…The original ICDPIC program was developed for use with ICD-9-CM codes, but ICDPIC-R allows the use of both ICD-9-CM and ICD-10-CM codes, with options to calculate injury severity directly from ICD-10-CM codes (based on diagnosis-specific mortality estimates from the National Trauma Data Bank) or indirectly by first mapping ICD-10-CM codes to ICD-9-CM codes using the Centers for Medicare & Medicaid Services' (CMS') General Equivalence Mapping (GEM) tables. We chose to use the GEM minimum severity method for converting ICD-10-CM codes to ICD-9-CM codes because this strategy resulted in minimal disruption in trends across the coding transition [ 41 ]. Hospital characteristics, such as trauma center status and level, were not able to be considered because hospital identifiers that could be used to link the SID to other data at the hospital level were not available for Georgia, Kansas, or Missouri.…”

Lessons in Linkage: Combining Administrative Data Using Deterministic Linkage for Surveillance of Sports and Recreation Injuries in Florida, United States

“…Future work will illustrate the methodology using ICD-10-CM and how we approached linking data across ICD versions. Few, if any, data sources to date have converted older data in ICD-9-CM to ICD-10-CM or ICD-10 to ICD-11 though some crosswalks exist for these specific purposes [45][46][47][48].…”