A new study reveals that pediatricians may lose money and clinical information thanks to the ICD-10 transition.
The study, from researchers at the University of Illinois at Chicago (UIC), looked at ICD-9 to ICD-10 mappings for pediatrics and which current codes could potentially cause financial or information loss if they were mapped incorrectly to ICD-10 codes. Using the 2010 Illinois Medicaid data to identify ICD-9-CM codes for pediatric patients treated at the University of Illinois Hospital & Health Sciences System, the researchers determined 2,708 diagnosis codes used by pediatricians in 174,500 patient encounters for a total Medicaid payment of $12,298,520.
Using a self-developed web-based tool, the researchers mapped those codes to ICD-10 codes and then categorized them by the complexity of the transition--from easy to hard. They found that 26 percent of pediatric ICD-9 codes have complex mapping to ICD-10, representing 21 percent of Illinois Medicaid pediatric patient encounters and 16 percent of total reimbursements. As an example, the researchers pointed out how the ICD-9 code V38.30 "Twin, mate stillborn" maps to ICD-10 code Z38.30 "Twin liveborn."
"Many pediatric practices, perhaps more than other medical fields, practice on a narrow financial margin and are often reimbursed at lower rates than other specialties, particularly by Medicaid," Rachel Caskey, M.D., UIC assistant professor of pediatrics and co-author of the study, said in a statement.
This is not the first study from UIC on ICD-10 transition, and specifically the financial and data loss that comes from incorrect mappings. As noted in previous studies by UIC, an incorrect mapping could mean practices may not get reimbursed and clinical information could be lost.
This study was published in Pediatrics.
University of Illinois at Chicago