ICD-10 Transition Poses Problems for ICD-9 Translation

Where there was once one code, under ICD-10 there may be 300 or 400. "As we continue to evolve, individual preferences could impact revenues, reports, and other data," says a health information sciences researcher.

The transition to the ICD-10 diagnostic code set on Oct. 1 will complicate financial and clinical forecasting and analyses that also rely upon data compiled under the outmoded ICD-9 code, researchers say.

"Everything from staffing levels to payment and even protecting margins, all of this is based on the ICD-9 codes. All of these reports have to be changed," says Andrew Boyd, assistant professor of biomedical and health information sciences at the University of Illinois, Chicago.

"It's not just learning the new system, it's learning how to interpret the new system."

Boyd, the lead author of a recent online study in the Journal of the American Medical Informatics Association, says the new, more granular data made available under ICD-10 will be very valuable for a healthcare delivery system that's evolving towards value-based care and population health. In the short term, however, the transition could prove to be problematic.

"The increased fidelity is going to be great, but increased fidelity of the codes does not necessarily reflect the increased fidelity of the actual information," he says.

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Boyd says the uncertainty around translating back and forth between ICD-9 and ICD-10 codes could prompt some clinicians "to become closer to artists with all the different ways of describing disease than historically with ICD-9."

"We have all these codes and one person moving from institution to institution might increase or decrease reimbursements because of individual preferences," he says. "Literally where we might have one code now there will be 300 or 400 under ICD-10. As we continue to evolve, individual preferences could impact revenues, reports and other data."

Sue Bowman, senior director, coding policy and compliance, at the American Health Information Management Association, concedes that the transition to ICD-10 will come with some bumps.

"It makes sense that it would be somewhat difficult because if the two codes sets were a simple one-to-one map-and-compare there wouldn't be much point in going to a new system," Bowman says. "Whenever you go to a new coding system there are going to be challenges trying to compare data collected under the old system with data collected under the new system."

Bowman says coders, clinicians and researchers have to understand that the transition to ICD-10 will also create a new granularity of data that now does not exist.

"Obviously you can't produce things out of the ICD-9 data that didn't exist in the ICD-9 codes," Bowman says. "You can't look at laterality and specificity that only exists in ICD-10. Another thing is that the changes in understanding medicine and medical practice have changed so the 10 data is more reflective of modern understanding of medicine."

 "When people are looking at data they have to keep in mind that if there appear to be significant changes in instances of clinical conditions and other factors they have to look at whether it could be a change in the coding system rather than a real change in clinical practices or circumstances," she says.

Boyd and other UIC researchers in 2013 created a free web portal tool and translation tables that facilitate transitions and cross referencing from ICD-9 to ICD-10, and back.

"The method we propose will give you mapping backwards to 99% of the ICD-9 and 10 codes. It is a complete mapping, as much as you can do from government data," Boyd says. "If you use other types of tools you will miss either 30% of the ICD-9 or 75% of the ICD-10 data."

Boyd says the transition can be a little smoother with training and preparation.

"You need to train and understand and know what information is needed for you to function as a health facility," Boyd says. "It's not just learning the new information, it's what information do you need to run your business. Some hospitals have 1,500 reports with ICD-9 codes buried in them. Do you need to recode all of them? Are they all critical? Which are important?"