Because codes for Patient Safety Indicators often do not map directly from ICD-9 to ICD-10, the transition to ICD-10 may cause the frequency of adverse events to be misreported, according to a recent study in the Journal of the American Medical Informatics Association.
Of a sample of 23 PSI ICD-9 codes, just three had an equivalent ICD-10 code. For 15 of the codes, the mapping was 'convoluted,' often meaning more than one ICD-9 code translated into the same ICD-10 code. Five of the 23 PSI codes were either depreciated or had no ICD-10 equivalent.
To determine the effect these mapping issues would have on adverse event reporting, researchers studied a sample of 1,446,581 Medicaid visits in Illinois. Researchers used the visits' ICD-9 codes to determine the number of visits including a PSI indicator, and compared these results to the PSIs represented after the visits were coded using ICD-10. Results showed both under- and overreporting of adverse events based on the transition to ICD-10.
This could lead to misleading quality data from providers, write the authors. "PSI results published on public reporting sites, such as Hospital Compare, could be non-representative of a safe hospital environment, which is a burden to patients," they write. "Finally, ethical organizations addressing 'data-, process-, and system-focused' improvements could be penalized using the new ICD-10-CM AHRQ PSIs because of apparent increases in PSIs bearing the same PSI identifier and label, yet calculated differently."
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