martes, 23 de febrero de 2016


Simulation of ICD-9 to ICD-10-CM Transition for Family Medicine: Simple or Convoluted?

Samuel N. Grief, MD; Jesal Patel, BS; Karl M. Kochendorfer, MD; Lee A. Green, MD; Yves A. Lussier, MD; Jianrong Li, MSc; Michael Burton, MSc; Andrew D. Boyd, MD
J Am Board Fam Med. 2016;29(1):29-36. 
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Abstract and Introduction


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 <0.1% of the overall diagnosis codes.
Conclusions: The transition to ICD-10-CM is simple for 70% or more of diagnosis codes, visits, and reimbursement for a family medicine physician. However, some frequently used codes for disease management are convoluted and incorrect, and for which additional resources need to be invested to ensure a successful transition to ICD-10-CM.


The transition to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), will have a huge impact on practicing physicians in the United States.[1] The transition date of ICD-10-CM was October 1, 2015. The list of potential diagnosis codes in ICD-10-CM is 5 times larger than its International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) counterpart currently used in practice.[2]The American Medical Association estimates that the cost of the transition to ICD-10-CM is between $83,000 and $2 million per physician practice.[1] A more recent Medical Management Group Association report revealed that the average cost to upgrade/replace practice management systems to use ICD-10-CM diagnosis codes per full-time-equivalent practitioner is $10,190.00.[3] Additional costs to upgrade/replace electronic health records to use ICD-10-CM diagnosis codes will average $9,979.00 per full-time-equivalent practitioner.[3] Previous studies have evaluated a number of different medical specialties with regard to the transition to ICD-10-CM.[4–6] The recent ruling by the Center for Medicaid and Medicare Services (CMS) to not deny any claim because of a lack of specificity for the first year during the transition to ICD-10-CM highlights the challenge and potential impact of the new coding system.[7] To our knowledge, no other studies have evaluated the impact ICD-10-CM will have on the practice of family medicine.
The United States is the last country to transition to ICD-10-CM. The difficulties in making this national transition are multifactorial, but all can be overcome.[8] Some concerns, as evidenced by a Swiss study, showed that it took up to 5 years before ICD-10-CM became as accurate as ICD-9-CM.[9] In a Canadian study, the use of ICD-10-CA (the Canadian version of ICD-10-CM but with fewer codes) had a variable impact on quality compared with ICD-9-CM.[10] The objective of this study was to examine the impact of ICD-10-CM on family medicine and identify areas where additional training and preparation might be required. The study was approved and given exempt status by our institutional review board (approval no. 2012-0773).Continue Reading

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