The October 1 deadline to transition from ICD-9 to ICD-10 poses special challenges for emergency departments in terms of how medical diagnoses are coded. According to new research, about a quarter of all ER clinical encounters could experience difficulties after the code switchover this fall.

ICD-10 includes more than 68,000 diagnostic codes versus just 14,000 such codes for ICD-9. Researchers looked specifically at the codes most often used by emergency physicians and reviewed how ICD-9 codes map to ICD-10 codes. What they found was that some ICD-9 codes translate well, but many more have convoluted mappings—and some simply don’t map at all.

The study was funded by the University of Illinois at Chicago Center for Clinical and Translational Sciences and Institute for Translational Health Informatics, as well as the Office of the Vice President for Health Affairs of the University of Illinois Hospital and Health Sciences System.

“ICD-9-CM to ICD-10-CM transition is not straightforward and contains hidden mapping and planning challenges that may have not been accounted for even at this late stage of the sprint toward ICD-10-CM implementation,” conclude the researchers. “These challenges, if not addressed, may carry significant cost and workflow issues that will be shared by providers and payers alike.”

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The aim of the study, published in the May issue of the American Journal of Emergency Medicine, was to reveal actual emergency diagnostic code complexities using a set of Medicaid data from the state of Illinois and link these complexities to visit encounters. Researchers found that 27 percent of the 1,830 commonly used ER ICD-9 codes had convoluted mappings that could create problems with reporting or reimbursement. They also discovered that when they looked at more than 24,000 actual clinical encounters in the ER, 23 percent could be assigned incorrect codes if the recommendations of the Centers for Medicare and Medicaid Services were actually followed.

“Hospitals and emergency departments rely on correct classification of diagnoses for proper hospital reimbursement, clinical documentation, case-mix acuity indices, medical necessity for procedures, services and admissions, and reporting of disease to public health departments,” states the article. “However, although CMS provides forward and backward mappings between ICD-9-CM and ICD-10-CM classifications, many codes share complex reciprocal relationships that may lead to confusion and incorrect coding. This issue has potential to be exacerbated by the fact that a significant percentage of the billed codes are highly complex, pointing to the problem of ICD-10-CM conversion complexity and the increased number of clinically incorrect codes used under the ICD-10-CM classification.”

In addition, given the increased complexity, researchers argue that “physician groups attempting to perform coding internally (rather than relying on outsourcing agencies) may encounter challenges in adoption that will require dramatic changes to current procedures and operations.”

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