The Complexity and Challenges of ICD-10 Transition in Emergency Departments

According to a recent paper published by the American Journal of Family Medicine emergency departments will feel a negative impact from the changeover to the new ICD-10 coding system.

According to the researchers at the University of Illinois at Chicago, more than 27% of the 1,830 common used emergency department ICD-9 codes billed to Illinois Medicaid were convoluted, whereas 8% were found to be clinically incorrect. The study goes on further to state that these findings are significant because they point to potentially higher complexity and impact of the conversion that could affect clinical workflow and financial health of the hospitals and carry negative clinical research implications, the authors say.

The new international disease classification system, known as ICD-10, is to be fully implemented Oct. 1. It includes more than 68,000 diagnostic codes — compared to 14,000 in its predecessor, ICD-9. Because of significant changes in the diagnostic codes for OB/GYN in ICD version 10, there is potential for clinically incorrect mappings to translate into significant cost challenges for EDs that have not grasped the extent of these changes and did not take appropriate steps to review and mitigate business risks.

The study also cautions that emergency departments aren’t alone in facing ICD-10 transition challenges. They cite prior studies that show convoluted mappings and information loss in non-ED settings, such as pediatrics and hematology-oncology. Independent physician groups staffing EDs and performing their own billing will face even greater challenges because of the fewer resources typically available in these smaller organizations. Many of such organizations still perform their own coding and may be overwhelmed by the sheer amount of analysis and challenges posed by ICD-10, from software upgrades to dealing with vastly expanded number of codes.

In their latest study, the UIC researchers looked specifically at the codes used most often by emergency physicians, to see where problems may arise

“Despite the wide availability of information and mapping tools, some of the challenges we face are not well understood,” says Dr. Andrew Boyd, assistant professor of biomedical and health information sciences at UIC and principal investigator on the study.

You can read the full study here. UIC team developed a free online mapping tool that reports the ICD-9 to IDC-10 code mappings, available here.