Potential for Financial Disruption From ICD-10 Transition
Financial disruption, administrative errors for 8 percent of Medicaid peds reimbursement codes
THURSDAY, June 5, 2014 (HealthDay News) -- With the transition to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), 8 percent of Medicaid pediatric reimbursement diagnosis codes may result in financial disruption and administrative errors, according to a study published online June 2 in Pediatrics.
Rachel Caskey, M.D., from the University of Illinois at Chicago, and colleagues examined the potential impact of the transition to ICD-10-CM. A total of 2,708 diagnosis codes were identified from ICD-9-CM using a data set from Illinois Medicaid specified for pediatricians, and the codes were categorized (identity, class-to-subclass, subclass-to-class, convoluted, and no translation). The 636 convoluted and high-cost diagnostic codes were analyzed for accuracy and classified as information loss, overlapping categories, inconsistent, and consistent. For each category, reimbursement by Medicaid was calculated.
The researchers found that about one-quarter (26 percent) of pediatric diagnostic codes were convoluted, representing 21 percent of Illinois Medicaid pediatric patient encounters and 16 percent of reimbursement. Eight percent of Medicaid pediatric reimbursement was accounted for by diagnosis codes representing information loss (3.6 percent), overlapping categories (3.2 percent), and inconsistent (1.2 percent) categories.
"The potential for financial disruption and administrative errors from 8 percent of reimbursement diagnosis codes necessitates special attention to these codes in preparing for the transition to ICD-10-CM for pediatric practices," the authors write.