Transition to international classification of disease version 10, clinical modification: the impact on internal medicine and internal medicine subspecialties.
BMC Health Serv Res
; 18(1): 328, 2018 05 04.
Article
em En
| MEDLINE
| ID: mdl-29728145
ABSTRACT
BACKGROUND:
The US health care system uses diagnostic codes for billing and reimbursement as well as quality assessment and measuring clinical outcomes. The US transitioned to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) on October, 2015. Little is known about the impact of ICD-10-CM on internal medicine and medicine subspecialists.METHODS:
We used a state-wide data set from Illinois Medicaid specified for Internal Medicine providers and subspecialists. A total of 3191 ICD-9-CM codes were used for 51,078 patient encounters, for a total cost of US $26,022,022 for all internal medicine. We categorized all of the ICD-9-CM codes based on the complexity of mapping to ICD-10-CM as codes with complex mapping could result in billing or administrative errors during the transition. Codes found to have complex mapping and frequently used codes (n = 295) were analyzed for clinical accuracy of mapping to ICD-10-CM. Each subspecialty was analyzed for complexity of codes used and proportion of reimbursement associated with complex codes.RESULTS:
Twenty-five percent of internal medicine codes have convoluted mapping to ICD-10-CM, which represent 22% of Illinois Medicaid patients, and 30% of reimbursements. Rheumatology and Endocrinology had the greatest proportion of visits and reimbursement associated with complex codes. We found 14.5% of ICD-9-CM codes used by internists, when mapped to ICD-10-CM, resulted in potential clinical inaccuracies.CONCLUSIONS:
We identified that 43% of diagnostic codes evaluated and used by internists and that account for 14% of internal medicine reimbursements are associated with codes which could result in administrative errors.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
Base de dados:
MEDLINE
Assunto principal:
Classificação Internacional de Doenças
/
Medicaid
/
Medicina Interna
Tipo de estudo:
Health_economic_evaluation
/
Prognostic_studies
Limite:
Female
/
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
BMC Health Serv Res
Ano de publicação:
2018
Tipo de documento:
Article