A recent study showed switching from ICD 9 to ICD 10 can result in missed codes and inaccurate billing charges
Researchers at the University of Illinois at Chicago recently conducted an experiment to assess the difficulty of transitioning from ICD 9 to ICD 10 codes. The results of the experiment, which were published in the Journal of Oncology Practice, showed significant and worrisome information loss, which in turn resulted in reduced Medicaid reimbursements.
The researchers focused on the codes affecting hematology-oncology diagnoses. After looking at ICD 9 codes and reimbursements from Illinois Medicaid data and from the University of Illinois Cancer Center’s physician practices, the researchers identified the 100 most-used codes and the 120 highest-reimbursement codes. These codes were then fed into software designed to convert them to ICD 10.
When the researchers studied the resulting data, they found that a significant loss of information had occurred. About 8 percent of Medicaid codes and 1 percent of codes from the University’s cancer clinic were affected. This in turn affected about 2.9 percent of total Medicaid reimbursements and 5.3 percent of the cancer clinic’s billing charges. The published report identifies the specific codes that triggered the information and reimbursement losses to enable health care providers to remain alert for possible issues associated with these codes.
What Went Wrong?
The reason that the transition from ICD 9 to ICD 10 codes introduced information and financial losses has to do with the nature of the two code sets. ICD 9 is much smaller, having only about 14,000 codes. ICD 10 is much more robust, with over 69,000 codes. The larger code set is necessary to reflect new technology and enable the capture of more detailed information about patient care. But because the two code sets do not directly map to one another, it can be challenging to switch from one set to another. Even with hematology-oncology, which is thought to be one of the sections of the new code set with the fewest codes and the simplest mappings, significant challenges exist, as the study clearly shows.
What Can You Do About It?
Inaccurate coding is a serious matter affecting not only patient care, but also business decisions that are vital to the successful operation of a physician practice or insurance company. In order to ensure the best possible coding accuracy when adopting ICD 10, it is important to have highly skilled coding staff members that are intimately familiar with both the old and the new code set. At HCC Coders, we can provide fully trained, pre-screened coders to work for you on a full time or part time basis. We can even offer coders with specific specialties to further enhance the quality of your data and the amount of your reimbursements.