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Journal ArticleDOI

PS3-11: Beyond General Equivalency Mappings (GEMs): Understanding the Implications of ICD 10 in Research

Rick Riordan1
01 Sep 2013-Clinical Medicine & Research (Marshfield Clinic)-Vol. 11, Iss: 3, pp 177-177

TL;DR: ICD 10 offers a finer level of detail and a higher level of specificity, thereby allowing research teams to be more targeted when pulling data, and research teams need to exercise caution when using GEMs and other tools to translate ICD 9 codes into ICD 10 codes and vice versa.

AbstractBackground/Aims With the implementation of ICD 10 CM and ICD 10 PCS less than two years away, there are still unanswered questions as to how research teams will effectively translate or use ICD 10 codes in research. Approximately 84% of the ICD 10 codes have only approximate matches with 10% having multiple matches and only 5% have exact one-to-one matches between ICD 9 and ICD 10. With the number of codes increasing five-fold, this offers additional opportunities and risks when pulling data.

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Journal ArticleDOI
TL;DR: This work provides the first report of substantial hospital safety reporting errors with five direct comparisons from the 23 types of PSIs (transfusion and anesthesia related PSIs), and investigates which PSIs would reliably transition between ICD-9-CM and I CDD-10-CM, and those at risk of under-reporting and over-reporting adverse events while the frequency of these adverse events remain unchanged.
Abstract: Reporting of hospital adverse events relies on Patient Safety Indicators (PSIs) using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes. The US transition to ICD-10-CM in 2015 could result in erroneous comparisons of PSIs. Using the General Equivalent Mappings (GEMs), we compared the accuracy of ICD-9-CM coded PSIs against recommended ICD-10-CM codes from the Centers for Medicaid/Medicare Services (CMS). We further predict their impact in a cohort of 38 644 patients (1 446 581 visits and 399 hospitals). We compared the predicted results to the published PSI related ICD-10-CM diagnosis codes. We provide the first report of substantial hospital safety reporting errors with five direct comparisons from the 23 types of PSIs (transfusion and anesthesia related PSIs). One PSI was excluded from the comparison between code sets due to reorganization, while 15 additional PSIs were inaccurate to a lesser degree due to the complexity of the coding translation. The ICD-10-CM translations proposed by CMS pose impending risks for (1) comparing safety incidents, (2) inflating the number of PSIs, and (3) increasing the variability of calculations attributable to the abundance of coding system translations. Ethical organizations addressing ‘data-, process-, and system-focused’ improvements could be penalized using the new ICD-10-CM Agency for Healthcare Research and Quality PSIs because of apparent increases in PSIs bearing the same PSI identifier and label, yet calculated differently. Here we investigate which PSIs would reliably transition between ICD-9-CM and ICD-10-CM, and those at risk of under-reporting and over-reporting adverse events while the frequency of these adverse events remain unchanged.

17 citations


Journal ArticleDOI
TL;DR: A web portal tool and translation tables to list all I CD-9-CM diagnosis codes related to the specific input of ICD-10- CM diagnosis codes and their level of complexity and guidance on ambiguous and complex translations to reveal where reports or analyses may be challenging to impossible.
Abstract: In the United States, International Classification of Disease Clinical Modification (ICD-9-CM, the ninth revision) diagnosis codes are commonly used to identify patient cohorts and to conduct financial analyses related to disease. In October 2015, the healthcare system of the United States will transition to ICD-10-CM (the tenth revision) diagnosis codes. One challenge posed to clinical researchers and other analysts is conducting diagnosis-related queries across datasets containing both coding schemes. Further, healthcare administrators will manage growth, trends, and strategic planning with these dually-coded datasets. The majority of the ICD-9-CM to ICD-10-CM translations are complex and nonreciprocal, creating convoluted representations and meanings. Similarly, mapping back from ICD-10-CM to ICD-9-CM is equally complex, yet different from mapping forward, as relationships are likewise nonreciprocal. Indeed, 10 of the 21 top clinical categories are complex as 78% of their diagnosis codes are labeled as “convoluted” by our analyses. Analysis and research related to external causes of morbidity, injury, and poisoning will face the greatest challenges due to 41 745 (90%) convolutions and a decrease in the number of codes. We created a web portal tool and translation tables to list all ICD-9-CM diagnosis codes related to the specific input of ICD-10-CM diagnosis codes and their level of complexity: “identity” (reciprocal), “class-to-subclass,” “subclass-to-class,” “convoluted,” or “no mapping.” These tools provide guidance on ambiguous and complex translations to reveal where reports or analyses may be challenging to impossible. Web portal: Tables annotated with levels of translation complexity:

13 citations