Study: Information and Financial Losses Expected With ICD-10 Transition

Converting from ICD-9 to ICD-10 will result in information and financial losses to providers, report researchers from the University of Illinois at Chicago (UIC). Researchers there reviewed coding ambiguities for oncology and hematology diagnoses that clinicians may face as the October 1 switchover approaches.

"What we found was the transition led to significant information loss, affecting about 8 percent of the Medicaid codes and 1 percent of the codes in our cancer clinic," said Neeta Venepalli, MD, assistant professor of Oncology/Hematology at the UIC and co-author of the study.

The cost to implement with new hardware, software, and training will be significant as well. The American Medical Association estimates that the cost of implementation of ICD-10 will range from $83,000 to $2.7 million, depending on the size of the physician practice.^1-4

Hospitals will not be immune, either, as the American Society of Clinical Oncology anticipates implementation costs to range from $500,000 to $1.5 million for facilities with 100 to 400 beds and $1.5 to $5 million for facilities with more than 400 beds.⁵

The researchers found that 39 ICD-9-CM codes with information loss accounted for 2.9 percent of total Medicaid reimbursements and 5.3 percent of University of Illinois Cancer Center (UICC) billing charges.

In the study, the researchers used 2010 Illinois Medicaid data to identify ICD-9-CM outpatient codes and the associated reimbursements used by oncologists and hematologists. The researchers identified 120 codes with the highest reimbursement for analysis.

They also looked at ICD-9-CM outpatient diagnosis codes and associated billing charges used by UICC physicians from 2010 to 2012 and selected the 100 most-used codes.

Using a web-based tool developed at UIC, the researchers input the ICD-9 codes and translated them into ICD-10 codes. They looked at whether the translation made sense; whether a loss of clinical information occurred; and whether a loss of information had financial implications.

The authors write that “by identifying codes at risk for complex transitions, the analytic tools described can be replicated for oncology practices to forecast areas requiring additional training and resource allocation.” The authors conclude that the complex transitions and diagnosis codes associated with information loss within clinical oncology require additional attention during the transition to ICD-10-CM.

The study is published in the March issue of The Journal of Oncology Practice.

References:

1. Office of the Secretary HHS: Administrative simplification: Adoption of a standard for a unique health plan identifier; addition to the National Provider Identifier requirements; and a change to the compliance date for the International Classification of Diseases, 10th Edition (ICD-10-CM and ICD-10-PCS) medical data code sets. Final rule. Federal register 77:54663-720, 2012.

2. Medical Group Management Association Press Room: Fact sheet. http://www.mgma.com/about/press-room/press-releases/2007-2012/10-14-2008-new-icd-10-study

3. Nachimson Advisors, LLC: The impact of implementing ICD-10 on physician practices and clinical laboratories. www.nachimsonadvisors.com/Documents/ICD-10%20Impacts%20on%20Providers.pdf

4. Madara JL: American Medical Association response: Re administrative simplification—Change to the compliance date for ICD-10-CM and ICD-10-PCS medical data code sets; CMS-0040-P; RIN 0938-AQ13. http://www.ama-assn.org/resources/doc/washington/icd-10-comment-letter-10may2012.pdf

5. A HIMSS G7 Advisory Report: ICD-10 transformation: Five critical risk mitigation strategies. http://himss.files.cms-plus.com/HIMSSorg/content/files/icd10/G7AdvisoryReport_ICD10%20Version12.pdf