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Frustration mounted earlier this year when the implementation date for ICD-10 was pushed back another year. Hospitals and physician practices spent a lot of money and time to change 14,000 codes for ICD-10. And now a study from the Journal of the American Medical Informatics Association may add to the annoyance: Certain patient safety codes could make safety reporting worse.
Researchers from the University of Chicago compared 23 patient safety indicators (PSIs) between the current ICD-9 codes and new ICD-10 codes to track the equivalence and accuracy of reporting. Only three ICD-9 PSIs had ICD-10 equivalents, while 15 had “convoluted” equivalents and five had none at all. This could cause complications in patient safety reporting, as some patient safety events could suddenly become inflated, while others will decrease. For example, with accidental organ puncture or laceration, “[t]he completely new organ focus of ICD-10-CM is different from the procedure focus of the ICD-9-CM puncture or laceration, which could lead to under-reporting as there would be an additional need to read the operative report for the specific location of the puncture or laceration,” the researchers wrote.
The difference in coding could lead to physician offices or hospitals accidentally – or intentionally -- underreporting safety incidents, inflation of PSIs due to ICD-10’s different coding, and increased variability in calculations. “PSI results published on public reporting sites, such as Hospital Compare, could be non-representative of a safe hospital environment, which is a burden to patients,” the researchers wrote.
New codes that could quite possibly inflate PSI numbers could be unwelcome news for physicians, especially in the face of Medicare reimbursement penalties for quality and patient safety measures.