Transition to ICD-10 may cause loss of information and revenue for health care professionals

Health care professionals may experience losses of both information and revenue during the mandatory conversion from the current ICD-9 (International Classification of Diseases) to ICD-10. This information loss may affect enough billing costs to eliminate the operating margin of an oncology practice.

Implementation of ICD-10 is scheduled for October 1, 2014 but may be delayed because many doctors and hospitals are not ready for the change.

The ICD system classifies diagnoses, symptoms, and procedures by numeric code. This code affects all aspects of health care, from insurance reimbursement to supply procurement to research studies. ICD-10 includes more than 68,000 diagnostic codes, compared to 14,000 in ICD-9.

This study published in the Journal of Oncology Practice (2014; doi: 10.1200/JOP.2013.001156) looked at coding ambiguity for hematology-oncology diagnoses as a predictor of difficulties during the transition from ICD-9 to ICD-10. Prior research suggested that the transition would be simpler in hematology-oncology because there are fewer ICD-10 codes and the information mappings are more straightforward when compared with other subspecialties.

Often, codes do not map one-to-one or one-to-many, said Andrew Boyd, MD, assistant professor in biomedical and health information sciences at the University of Illinois (UI) in Chicago, and a co-author of the study. A cluster of codes might map to several ICD-10 codes, which might map back to different ICD-9 codes, he said.

In the study, the researchers used 2010 Illinois Medicaid data to identify ICD-9 outpatient codes and associated reimbursements used by hematology-oncology physicians, and selected the 120 codes with the highest reimbursement. In addition, they looked at ICD-9 outpatient diagnosis codes and associated billing charges used by University of Illinois Cancer Center physicians from 2010 to 2012, and determined the 100 most-used codes.

Using these two sets of data, the researchers entered the ICD-9 codes into a web-based conversion tool that translated them into ICD-10 codes. They looked at whether the translation made sense, whether a loss of clinical information occurred, and whether a loss of information had financial implications.

“We found 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 Neeta Venepalli, MD, assistant professor of hematology and oncology at the University of Illinois in Chicago, and first author of the study.

The researchers found that 39 ICD-9 codes with information loss accounted for 2.9% of total Medicaid reimbursements and 5.3% of UI Cancer Center billing charges. This is significant because information loss affecting 5% of billing costs could obliterate the operating margin of a practice. The study highlighted the 39 codes that had the highest association with complex transitions and reimbursement issues. This information will enable oncology practices to focus additional training on these areas.

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