Simulation of ICD-9 to ICD-10-CM transition for family medicine: Simple or convoluted?

Samuel N. Grief, Jesal Patel, Karl M. Kochendorfer, Lee A. Green, Yves A Lussier, Jianrong Li, Michael Burton, Andrew D. Boyd

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: The objective of this study was to examine the impact of the transition from International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), to Interactional Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), on family medicine and to identify areas where additional training might be required. Methods: Family medicine ICD-9-CM codes were obtained from an Illinois Medicaid data set (113,000 patient visits and $5.5 million in claims). Using the science of networks, we evaluated each ICD-9-CM code used by family medicine physicians to determine whether the transition was simple or convoluted. A simple transition is defined as 1 ICD-9-CM code mapping to 1 ICD-10-CM code, or 1 ICD-9-CM code mapping to multiple ICD-10-CM codes. A convoluted transition is where the transitions between coding systems is nonreciprocal and complex, with multiple codes for which definitions become intertwined. Three family medicine physicians evaluated the most frequently encountered complex mappings for clinical accuracy. Results: Of the 1635 diagnosis codes used by family medicine physicians, 70% of the codes were categorized as simple, 27% of codes were convoluted, and 3% had no mapping. For the visits, 75%, 24%, and 1% corresponded with simple, convoluted, and no mapping, respectively. Payment for submitted claims was similarly aligned. Of the frequently encountered convoluted codes, 3 diagnosis codes were clinically incorrect, but they represent only

Original languageEnglish (US)
Pages (from-to)29-36
Number of pages8
JournalJournal of the American Board of Family Medicine
Volume29
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

International Classification of Diseases
Medicine
Family Physicians
Medicaid

Keywords

  • Clinical Coding
  • Electronic Medical Records
  • Family Practice
  • Medical Informatics

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice

Cite this

Simulation of ICD-9 to ICD-10-CM transition for family medicine : Simple or convoluted? / Grief, Samuel N.; Patel, Jesal; Kochendorfer, Karl M.; Green, Lee A.; Lussier, Yves A; Li, Jianrong; Burton, Michael; Boyd, Andrew D.

In: Journal of the American Board of Family Medicine, Vol. 29, No. 1, 01.01.2016, p. 29-36.

Research output: Contribution to journalArticle

Grief, Samuel N. ; Patel, Jesal ; Kochendorfer, Karl M. ; Green, Lee A. ; Lussier, Yves A ; Li, Jianrong ; Burton, Michael ; Boyd, Andrew D. / Simulation of ICD-9 to ICD-10-CM transition for family medicine : Simple or convoluted?. In: Journal of the American Board of Family Medicine. 2016 ; Vol. 29, No. 1. pp. 29-36.
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abstract = "Objective: The objective of this study was to examine the impact of the transition from International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), to Interactional Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), on family medicine and to identify areas where additional training might be required. Methods: Family medicine ICD-9-CM codes were obtained from an Illinois Medicaid data set (113,000 patient visits and $5.5 million in claims). Using the science of networks, we evaluated each ICD-9-CM code used by family medicine physicians to determine whether the transition was simple or convoluted. A simple transition is defined as 1 ICD-9-CM code mapping to 1 ICD-10-CM code, or 1 ICD-9-CM code mapping to multiple ICD-10-CM codes. A convoluted transition is where the transitions between coding systems is nonreciprocal and complex, with multiple codes for which definitions become intertwined. Three family medicine physicians evaluated the most frequently encountered complex mappings for clinical accuracy. Results: Of the 1635 diagnosis codes used by family medicine physicians, 70{\%} of the codes were categorized as simple, 27{\%} of codes were convoluted, and 3{\%} had no mapping. For the visits, 75{\%}, 24{\%}, and 1{\%} corresponded with simple, convoluted, and no mapping, respectively. Payment for submitted claims was similarly aligned. Of the frequently encountered convoluted codes, 3 diagnosis codes were clinically incorrect, but they represent only",
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