ICD-10 Switch Will Cause Problems in the ER

Researchers found 27 percent of the 1,830 commonly used emergency room ICD-9 codes had convoluted mappings that could create problems with reporting or reimbursement. Further, they found that when they looked at more than 24,000 actual clinical encounters in the ER, 23 percent could be assigned incorrect codes if recommendations of the Center for Medicare and Medicaid Services were followed.

During the past two years researchers extensively reviewed how ICD-9 codes map to ICD-10 codes, not only for emergency medicine, but for other problematic areas, including pediatrics, patient safety reporting and long-term research. Some ICD-9 indicator codes translate well, but many more have convoluted mappings — and some simply don’t map at all.

In their latest study, the UIC researchers looked specifically at the codes used most often by emergency physicians, to see where problems may arise.

“Despite the wide availability of information and mapping tools, some of the challenges we face are not well understood,” Dr. Andrew Boyd, assistant professor of biomedical and health information sciences at UIC and principal investigator on the study, said.

Problems due to ICD-10 will be more widespread for independent physician groups that staff EDs and perform their own billing, according to the report. They will be overwhelmed by the amount of analysis and challenges in ICD-10, so say the study authors.

Worries remain over ICD-10, especially for small practices. According to a survey from NueMD, a billing and practice management software vendor, the level of concern about ICD-10, especially among small practices, is “a little too high for comfort.” Legislation currently pending in Congress, dubbed the Cutting Costly Codes Act of 2015, sponsored by Rep. Ted Poe (R-Tex.), and supported by six of his Republican colleagues including Rep. Mike Rogers (R.-Ala.) and Rep. Mo Brooks (R.-Ala.), is an intention to block the mandated transition ICD-10 set to take effect Oct. 1.

The bill would also prohibit HHS from requiring the medical community to comply with the ICD-10 codes and allow the U.S. Government Accountability Office to conduct a study by consulting with medical community stakeholders to determine steps to “mitigate the disruption on health care providers resulting from a replacement of ICD-9 as such a standard,” according to a new article from Medscape Medical News.

“The new ICD-10 codes will not make one patient healthier,” Rep. Poe said in a news release. “What it will do is put an unnecessary strain on the medical community who should be focused on treating patients, not implementing a whole new bureaucratic language.”

While the Medical Association supports Rep. Poe’s legislation and is working to build support in the Alabama Congressional Delegation for ICD-10 delay, physicians are encouraged to make plans to prepare for the mandated transition should ICD-10 delay efforts prove unsuccessful.

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