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Researchers Link ICD-10 Shift to Financial Losses

John Commins, for HealthLeaders Media, March 17, 2014

The transition from ICD-9 to ICD-10 coding led to significant information loss at one oncology clinic, says a researcher who found that 39 ICD-9-CM codes with information loss accounted for 2.9% of total Medicaid reimbursements and 5.3% of the organization's billing charges.


Neeta Venepalli

Neeta Venepalli, MD
UIC Assistant Professor of Hematology/Oncology

Healthcare providers will see clinical and billing information and financial losses during the mandated switch to ICD-10 disease classification set later this year, a new study suggests.

The University of Illinois at Chicago study, published this month in the Journal of Oncology Practice, looked at entry ambiguities for hematology-oncology diagnoses in anticipation of the challenges providers may face during the transition from ICD-9-CM to ICD-10-CM, which takes effect on Oct. 1. UIC researchers focused on hematology-oncology because it has fewer ICD-10 codes and less convoluted mappings when compared with other sub-specialties.

The study used 2010 Illinois Medicaid data to identify ICD-9-CM outpatient codes and the associated reimbursements used by hematology-oncology physicians. Researchers identified 120 codes with the highest reimbursement for analysis. They also looked at ICD-9-CM outpatient diagnosis codes and associated billing charges used by University of Illinois Cancer Center physicians from 2010 to 2012 and selected the 100 most-used codes, the study said.

Using a web-based conversion tool developed at UIC, the ICD-9 codes were entered and translated into ICD-10 codes. Researchers looked at whether the translation made sense, whether a loss of clinical information occurred, and whether a loss of information had financial implications.


ICD-10: Minimizing the Financial Hit


"What we found was the transition from ICD-9 to ICD-10 led to significant information loss, affecting about 8% of the Medicaid codes and 1% of the codes in our cancer clinic," said Neeta Venepalli, MD, UIC assistant professor of hematology/oncology and lead author of the study.

Researchers found that 39 ICD-9-CM codes with information loss accounted for 2.9% of total Medicaid reimbursements and 5.3% of UI Cancer Center billing charges.

Venepalli and study co-author Andrew Boyd, an assistant professor in biomedical and health information sciences at UIC, spoke with HealthLeaders Media about the findings and what providers can do to prepare for Oct. 1. The following is an edited transcript.

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2 comments on "Researchers Link ICD-10 Shift to Financial Losses"


Dan Toren (3/18/2014 at 2:32 PM)
Great questions Susie. From 3M website:"How 3M became the ICD-10 leader Under contract with the Centers for Medicare and Medicaid Services (CMS), 3M designed and developed the ICD-10 Procedure Coding System (ICD-10 PCS) and the General Equivalence Mappings (GEMs). 3M also completed the initial conversion of the CMS MS-DRGs to ICD-10." Disclaimer: we have nothing to do with 3M. However, anticipating the angst of October 1st, we've developed and recently released an app that may help alleviate the anxiety related to the ICD-10 implementation - ICD10Doc. And yes, we have actually used GEM for mapping between ICD-9 and ICD-10. ICDDoc.com is intended especially for the small practices that don't have the support or budgets of a hospital HIM department. You can check it out at http://icd10doc.com Your feedback would be much appreciated Thanks Dan

Susie/Internal Medicine Practice Administrator (3/17/2014 at 10:54 AM)
I am still trying to figure out why there is the switch to ICD-10 in the first place. Real facts, not just government or insurance company public statements. Who wrote/created the GEMs? Is this evidence based medicine? When the author states that the maps may be wrong, most practices simply don't have the time or knowledge to create new algorithms. Is this tool for oncology only? Is this "map" ubiquitously used by Medicare and Commercial insurance companies? In other words, are they sharing the same GEMs? Any assistance would be greatly appreciated. Thank you in advance.