ICD-9 to ICD-10: Significant Data, Financial Losses from Transition

The transition to ICD-10 may cause both information and financial loss for providers, reveals the findings of a recent study from researchers at the University of Illinois at Chicago.

The researchers looked at the coding ambiguity for hematology-oncology diagnoses to anticipate the challenges all providers may face during the transition from ICD-9 to ICD-10, which is mandated for providers on Oct. 1, 2014 by the Centers for Medicare and Medicaid Services (CMS). They chose these specialties because prior research suggested that, compared to other sub-specialties, they would have a simpler transition, due to fewer ICD-10 codes and less convoluted mappings.

The researchers used Medicaid data in Illinois to identify ICD-9  outpatient codes and the associated reimbursements employed by hematology-oncology physicians. The researchers identified 120 codes with the highest reimbursement for analysis. They also looked at ICD-9 outpatient diagnosis codes and associated billing charges used by University of Illinois Cancer Center physicians from 2010 to 2012 and selected the 100 most-used codes.

They then used a web-based tool, developed in house, to input the ICD-9 codes and translated them into ICD-10 codes. They looked at whether the translation made sense; whether a loss of clinical information occurred; and whether a loss of information had financial implications.

“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,” Neeta Venepalli, M.D., UIC assistant professor of hematology/oncology and first author of the study, said in a statement. Further, there were financial losses as well. The researchers found that 39 ICD-9 codes with information loss accounted for 2.9 percent of total Medicaid reimbursements and 5.3 percent of UI Cancer Center billing charges.

This isn’t UIC’s first study in this area. Last year, researchers used CMS ICD-9 to ICD-10 mapping files, general equivalence mappings, and statewide Medicaid emergency department billing to determine that the mappings were convoluted. Many other studies, such as this one from Health Revenue Assurance Holdings (HRAA), a Plantation, Fla.-based coding vendor, say many hospitals are lagging on preparations for the ICD-10 transition.

Despite an industry backlash to the transition, CMS recently announced that it was not backing down from the Oct. 1 date.