Abstract 11693: Identifying Clinically Inaccurate Conversions From ICD-9 to ICD-10 in Cardiology Clinical Practice
Introduction: For the past 30 years, the ICD-9 clinical code set has been used to assign diagnoses to clinical encounters in the United States. On October 1, 2015 reimbursement will be tied to ICD-10, a code set which will increase code volume fivefold and increase cardiology specific codes 2.6 fold. This complex transition will affect billing, data collection, and inventory management among others. The government has proposed a General Equivalence Mapping from ICD-9 to ICD-10 but in practice this tool has been found to have limited clinical relevance. To better characterize the consequences of this transition and to predict inaccurate code pairings, we evaluated ICD-9 codes from Illinois cardiology clinics using an online conversion tool.
Methods: From the 2010 Illinois Medicaid database, 681 primary ICD-9 codes were used in cardiology clinics. 180 of these at high risk for information loss were identified and evaluated. These codes were visually mapped using the Lussier online conversion tool and were evaluated for clinical accuracy.
Results: Of 681 Medicaid sampled codes, 61 (9% total and evaluated) were found to lose clinical accuracy during conversion from ICD-9 to ICD-10. These diagnoses represented 331 visits and over $111,000 in associated costs (5% of visits and 9% of costs). The table below lists ten clinically inaccurate pairings associated with the highest cost.
Conclusions: Conversion of cardiology related codes from ICD-9 to ICD-10 from the Medicaid database is associated with loss of clinical information in 5% of all visits and 9% of associated costs. Targeting these at risk pairing will help prevent unnecessary loss of data and resources.
Author Disclosures: S.J. Chacko: None. R. Danziger: None. A. Boyd: None.
- © 2014 by American Heart Association, Inc.