Pediatricians may lose money, data or both during the mandated conversion from ICD-9 to ICD-10, according to University of Illinois at Chicago researchers.
The UIC researchers wanted to find out which codes could potentially cause financial or information loss if they were mapped to incorrect ICD-10 codes. They used 2010 Illinois Medicaid data to identify ICD-9-CM codes for pediatric patients treated at the University of Illinois Hospital and Health Sciences System.
They identified 2,708 diagnosis codes used by pediatricians in 174,500 patient encounters for a total Medicaid payment of $12,298,520. Using a web-based tool developed at UIC, the researchers input the ICD-9 codes and mapped them to ICD-10 codes.
The codes were then categorized by the complexity of the transition--from easy to complex or convoluted--and assessed for financial impact. Twenty-six percent of pediatric ICD-9 codes have complex mapping to ICD-10, representing 21 percent of Illinois Medicaid pediatric patient encounters and 16 percent of total reimbursements.
If pediatricians use incorrect mappings, or if insurers disagree with how examinations and procedures are coded, practices may not get reimbursed and clinical information can be lost, said Andrew Boyd, one of the studys co-authors. For example, the ICD-9 code V38.30 Twin, mate stillborn maps to ICD-10 code Z38.30 Twin liveborn.
Rachel Caskey, UIC assistant professor of pediatrics and co-author of the study, said the impact of such discrepancies on pediatrics practices could be substantial, given the lower margins many such practices, particularly outpatient practices with a large Medicaid constituency, operate with.
The study, published in Pediatrics, is available here.
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