Researchers identified 2,708 ICD-9 codes used by the University of Illinois Hospital & Health Sciences System in Chicago by analyzing 2010 Medicaid claims data. Using a code-mapping tool developed in-house, the researchers then mapped the codes onto the corresponding ICD-10 codes. Researchers then sorted the codes into five categories to help determine the complexity of the transition and the potential financial and operational impact — identity, class-to-subclass, subclass-to-class, convoluted and no translation.
The results showed 26 percent of codes in the study fell into the “convoluted” category, meaning there is no straightforward translation into ICD-10. Researchers determined these codes represent 21 percent of all Illinois Medicaid pediatric encounters and 16 percent of total pediatric Medicaid reimbursement in the state, meaning the transition to ICD-10 could cause a loss of both data and reimbursements for pediatric practices.
“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,” said study coauthor Rachel Caskey, MD, UIC assistant professor of pediatrics, in a news release. “Any discrepancies that could cause even a small decrease in reimbursement — even 5 percent — could have a substantial impact on some pediatric practices, particularly an outpatient practice with a large Medicaid population.”
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