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Mandated Coding Change Means Difficult Autumn Ahead for EDs

October 6th, 2016

CHICAGO – Forget goblins and witches this October. The changeover to ICD-10 required by the first of the month is much scarier than anything likely to occur on Halloween, according to a new study published recently in the American Journal of Emergency Medicine.

University of Illinois Chicago researchers suggest that nearly a quarter of all emergency department clinical encounters could pose difficulties. Justifying hospital admissions and reporting certain diseases to public health departments also might become more difficult, they posit.

Nearly 500 common used emergency ICD-9 codes – 27% of 1,830 – have convoluted mappings that could create problems with reporting or reimbursement, according to study results. In addition, when reviewing more than 24,000 actual ED clinical encounters, 23% of those codes with convoluted mappings were likely to be assigned incorrectly if CMS recommendations were followed.

"Despite the wide availability of information and mapping tools, some of the challenges we face are not well understood," said principal investigator Andrew Boyd, MD, assistant professor of biomedical and health information sciences at UIC. Boyd and his team have developed a free tool, available online, that reports the ICD-9 to ICD-10 code mappings.

Correct classification of diagnoses in the ED is necessary 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, the study points out.

CMS provides forward and backward mappings between ICD-9-CM and ICD-10-CM classifications, but study authors point out that 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.”

The researchers suggest that, because of increased complexity, emergency physician groups attempting to perform coding internally instead of outsourcing are likely to “encounter challenges in adoption that will require dramatic changes to current procedures and operations.”

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