ICD-10: A Transition That’s Already Happening
ICD-10, electronic health record
Background/Aims: The United States currently uses ICD version 9 (ICD-9) for diagnosis and procedure coding. Federal regulations require that U.S. health care providers adopt the next version (ICD-10) by 10/1/2015. The new version expands the number of diagnosis codes from about 13,000 to 68,000, and increases the number of procedure codes from approximately 4,000 to 90,000. The Centers for Medicare & Medicaid Services delayed its ICD-10 implementation date from 10/1/2014 to 10/1/2015 as a result of congressional action. However, changes to the electronic health records based on ICD-10 have continued to move forward. These changes include changing the pick lists that providers choose from as well as revamping the underlying data structures to support diagnoses coding.
Methods: The Center for Health Research Kaiser Northwest ICD-10 remediation team worked with research project staff to develop a set of diagnosis groupings (e.g. diabetes, renal disease, dementia, etc.) that can be coded under both ICD-9 and ICD-10. The team mapped the expanded provider selections to both ICD-9 and ICD-10. The team then developed a set of monitoring reports for these diagnosis groupings in order to look for points of discontinuity between ICD-9 and ICD-10.
Results: We found variation in rates of diagnosis groupings before and after the change to provider pick lists. Most diagnoses groupings have not shown a substantial change from the transition to more granularly defined diagnosis pick lists. However, when bilateral diagnosis codes are used, there can be irregularities in diagnosis rates.
Discussion: Preparing for ICD-10 has generated multiple changes to the electronic health record systems and their underlying data structures. Research projects should explore whether these changes are already impacting diagnoses and procedure-coding rates. In particular, research projects should look at trends in diagnoses rates when bilateral diagnosis codes are used.
Bauck AE, Allison M, Bachman D, Cleveland C, Crawford P, Gillespie S, Hu W. ICD-10: A Transition That’s Already Happening. J Patient Cent Res Rev 2015;2:116. http://dx.doi.org/10.17294/2330-0698.1140