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Emergency Medicine Braces for Changes in Diagnosis Codes

New system may pose problems for reimbursement and clinical documentation, authors say

Emergency medicine faces special challenges during this fall’s changeover in how medical diagnoses are coded. Nearly a quarter of all emergency room (ER) clinical encounters could pose difficulties, according to researchers at the University of Illinois at Chicago (UIC).

In addition to the problems the coding change may pose for reimbursement and proper clinical documentation, it will complicate tasks faced by emergency physicians, such as justifying hospital admissions and reporting certain diseases to public health departments, the investigators say. Their study was published in the May 2015 issue of the American Journal of Emergency Medicine.

The authors found that 27% of the 1,830 commonly used ER ICD-9 codes had convoluted mappings that could create problems with reporting or reimbursement. Further, they found that when they looked at more than 24,000 clinical encounters in the ER, 23% could be assigned incorrect codes if recommendations from the Centers for Medicare & Medicaid Services were followed.

The new international disease classification system, known as ICD-10, is to be fully implemented by October 1. It includes more than 68,000 diagnostic codes –– compared with 14,000 in its predecessor, ICD-9.

During the past 2 years, researchers at UIC have reviewed how ICD-9 codes map to ICD-10 codes, not only for emergency medicine but for other problematic areas, including pediatrics, patient safety reporting, and long-term research. Some ICD-9 indicator codes translated well, but many more had convoluted mappings –– and some didin’t map at all.

The researchers looked specifically at the codes used most often by emergency physicians to see where problems might arise.

“Despite the wide availability of information and mapping tools, some of the challenges we face are not well understood,” said principal investigator Dr. Andrew Boyd, an assistant professor of biomedical and health information sciences with UIC's Health Informatics and Health Information Management programs.

The UIC team developed a free online tool that converts ICD-9 to ICD-10 code mappings.

Sources: UIC; May 26, 2015; and Conversion Tool; 2015.


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