The complexity and challenges of the International Classification of Diseases, Ninth Revision, Clinical Modification to International Classification of Diseases, 10th Revision, Clinical Modification transition in EDs

Abstract

Beginning October 2015, the Center for Medicare and Medicaid Services will require medical providers to use the vastly expanded International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) system. Despite wide availability of information and mapping tools for the next generation of the ICD classification system, some of the challenges associated with transition from ICD-9-CM to ICD-10-CM are not well understood. To quantify the challenges faced by emergency physicians, we analyzed a subset of a 2010 Illinois Medicaid database of emergency department ICD-9-CM codes, seeking to determine the accuracy of existing mapping tools in order to better prepare emergency physicians for the change to the expanded ICD-10-CM system. We found that 27% of 1830 codes represented convoluted multidirectional mappings. We then analyzed the convoluted transitions and found that 8% of total visit encounters (23% of the convoluted transitions) were clinically incorrect. The ambiguity and inaccuracy of these mappings may impact the workflow associated with the translation process and affect the potential mapping between ICD codes and Current Procedural Codes, which determine physician reimbursement.

Figure 1

Example of the clinically incorrect IL Medicaid ICD-9-CM diagnosis codes The figure shows two clinically incorrect ICD-9-CM to ICD-10-CM code mappings, as determined by ED physicians, for the ICD-9-CM 682.6 (cellulitis and abscess of leg, except foot) and 625.9 (unspecified symptom associated with female genital organs) diagnosis codes.

Figure 2

2010 IL Medicaid emergency codes classification by complexity, clinical correctness, and encounters A shows the proportion of convoluted vs. simple ICD-9-CM to ICD-10-CM code mappings within the 2010 IL Medicaid dataset, along with corresponding encounters. Convoluted mappings represent a significant percentage of the total, leading to operational complexities and higher costs of conversion. B shows distribution of code mappings by clinical correctness within the same Medicaid dataset, along with corresponding encounters associated with these codes.