UIC Researchers Find ICD-10 Transition May Cause Confusion and Financial Losses

It will likely come as no surprise to health care providers preparing for the October 1 mandated switch from the current International Classification of Diseases to its updated version, but a study by University of Illinois at Chicago researchers finds that many providers could lose both information and money during the switch.

The researchers looked at coding ambiguity for hematology-oncology diagnoses because compared to other sub-specialties it had fewer ICD-10 codes and a somewhat simpler general equivalent mapping (GEM) code translation system. They theorized that if they encountered problems in this sub-specialty, all providers might face the same challenges.

They used 2010 Illinois Medicaid data to identify 120 ICD-9-CM outpatient codes with the highest associated reimbursements. In addition, they identified the 100 most-used codes by University of Illinois Cancer Center physicians from 2010 to 2012.

Next, they entered these high-reimbursement and frequently used ICD-9 codes into a web-based tool developed at UIC that translates ICD-9 codes into ICD-10 codes to see if the translations made sense, if any clinical information was lost, and if the translations would impact the provider’s reimbursement.

“What we found was the transition from ICD-9 to ICD-10 led to significant information loss, affecting about 8 percent of the Medicaid codes and 1 percent of the codes in our cancer clinic,” said Neeta Venepalli, M.D., UIC assistant professor of hematology/oncology and first author of the study, in a press release announcing the results.

In looking at the financial implications, the researchers found that 39 ICD-9-CM codes with information loss accounted for 2.9 percent of total Medicaid reimbursements and 5.3 percent of UI Cancer Center billing charges.

The study appears in the March issue of the Journal of Oncology Practice.