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New ICD-10 coding system poses complications to ED physicians

Over a quarter of ICD-9-Clinical Modification codes mapped incorrectly to ICD-10-Clinical Modification codes, with a small percentage being clinically inaccurate, according to recently published data. 

“ICD-9-[Clinical Modification] to ICD-10-[Clinical Modification] transition is not straightforward and contains hidden mapping and planning challenges that may have not been accounted for even at this late stage of the sprint toward ICD-10-[Clinical Modification] implementation,” Andrew D. Boyd, MD, of the department of biomedical and health information sciences at the University of Illinois, and colleagues wrote.

To assess the challenges that would be faced with the transition between systems and to identify code complexities, researchers compared codes most often used in the ED from the ICD-9 system with the new ICD-10 system using Illinois Medicaid data. 

Results demonstrated that among 1,830 frequently used ED diagnostic codes, 27% (n = 574) were improperly mapped. The diagnosis codes (574/1,830) represented 28% of total encounters.

Among the 622 codes that were assessed for clinical accuracy, which represented 8% of the total Illinois Medicaid emergency diagnostic codes, 23% were found to be clinically inaccurate. 

The researchers noted that significant changes in OB/GYN diagnostic coding occurred in the ICD-10 system, with 75% of delivery code mappings being clinically incorrect, which could potentially result in EDs facing substantial cost challenges.

A free tool that allows users to receive a report on the ICD-9-Clinical Modification (CM) to ICD-10-CM code mappings and classifications has been developed by researchers from the University of Illinois at Chicago. The tool can be found at www.lussierlab.org/transition-to-ICD10CM. 

“Despite the wide availability of information and mapping tools, some of the challenges we face are not well understood,” Boyd said in a press release. – by Casey Hower

Disclosure: Boyd reports he is a speaker for Epic, although the study was not relevant to any software developed by Epic. Please see the full study for a list of all other authors’ relevant financial disclosures.