Profiling by Care Setting Information Gain in the ... hobbs - Final... · Profiling by Care Setting...
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Profiling by Care Setting Information Gain in the Transition from ICD-9-CM to ICD-10-CM October 3, 2017 Sylvia Hobbs, MPH, Anne Medinus, PhD, Yaying Fu, BS, Kathy Hines A Combined All Payer Claims Data and Administrative Case Mix Approach • Review of the Coding Increases • Magnitude of Changes in Unspecified Codes • APCD and Case Mix care setting examples pre- and post- ICD-10-CM implementation • General Equivalency Mapping
Transcript of Profiling by Care Setting Information Gain in the ... hobbs - Final... · Profiling by Care Setting...
Profiling by Care Setting Information Gain in
the Transition from ICD-9-CM to ICD-10-CM
October 3, 2017
Sylvia Hobbs, MPH, Anne Medinus, PhD, Yaying Fu, BS, Kathy Hines
A Combined All Payer Claims Data and
Administrative Case Mix Approach
• Review of the Coding Increases• Magnitude of Changes in Unspecified Codes• APCD and Case Mix care setting examples pre- and
post- ICD-10-CM implementation• General Equivalency Mapping
1,638
1,219
432
148
609
1,776
711
452
840
280
1,037
495
1,480
351
501
472
3,557
1,465
1,358
Infectious and parasitic diseases (001-139)
Neoplasms (140-239)
Endocrine, nutrional and metabolic…
Diseases of the blood and blood-forming…
Mental disorders (290-319)
Diseases of the nervous system and…
Diseases of the eye and adnexa
Diseases of the ear and mastoid process
Diseases of the circulatory system (390-…
Diseases of the respiratory system (460-…
Diseases of the digestive system (520-579)
Diseases of the skin and subcutaneous…
Diseases of the musculoskeletal system…
Diseases of the genitourinary system…
Complications of pregnancy, childbirth,…
Certain conditions originating in the…
Congenital anomalies (740-759)
Symptoms, signs, and ill-defined…
Injury and poisoning (800-999)
Supplementary classification of external…
Supplementary classification of factors…
18,821 ICD-9-CM Codes
1,293
2,039
1,171
309
940
815
3,252
875
1,674
443
990
957
8,450
792
2,759
506
966
878
53,659
9,677
1,597
Certain infectious and parasitic diseases (A00-B99)
Neoplasms (C00-D49)
Endocrine, nutritional and metabolic diseases…
Diseases of the blood and blood-forming organs…
Mental, Behavioral and Neurodevelopmental…
Diseases of the nervous system (G00-G99)
Diseases of the eye and adnexa (H00-H59)
Diseases of the ear and mastoid process (H60-…
Diseases of the circulatory system (I00-I99)
Diseases of the respiratory system (J00-J99)
Diseases of the digestive system (K00-K95)
Diseases of the skin and subcutaneous tissue…
Diseases of the musculoskeletal system and…
Diseases of the genitourinary system (N00-N99)
Pregnancy, childbirth and the puerperium (O00-…
Certain conditions originating in the perinatal…
Congenital malformations, deformations and…
Symptoms, signs and abnormal clinical and…
Injury, poisoning and certain other consequences…
External causes of morbidity (V00-Y99)
Factors influencing health status and contact…
94,042 ICD-10-CM Codes
New Major Diagnosis Categories
Comparison of ICD-9-CM to ICD-10-CM Increase in Diagnosis
Codes by ICD-10-CM Major Diagnosis Chapters
59% of
ICD-10-CM codes are in the Injury/ poisoning chapter
“Codes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code. For those categories for which an unspecified code is not provided, the “other specified” code may represent both other and unspecified.”*
CMS Definition
* ICD-10-CM Official Guidelines for Coding and Reporting FY 2016. Department of Health and Human Services, Center for
Medicare & Medicaid Services, https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2016-ICD-10-CM-Guidelines.pdf
15%
9%
22%
8%
14%
11%
23%
11%
33%
13%
18%
9%
17%
13%
19%
14%
20%
20%
18%
0%10%20%30%40%
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
9%
21%
36%
12%
15%
15%
29%
16%
28%
24%
19%
15%
27%
31%
29%
15%
31%
16%
12%
28%
16%
0% 10% 20% 30% 40%
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
Percent Unspecified Diagnosis Codes18% of ICD-9-CM Codes 30% of ICD-10-CM Codes
MDC ICD-10-CM Diagnosis Major Group (Abbreviated)
1 Infectious & parasitic (Lower Unspecified)
2 Neoplasms
3 Blood & blood-forming organs & immune disorders (Lower Unspecified)
4 Endocrine, nutritional & metabolic
5 Mental, behavioral & neurodevelopmental
6 Nervous system
7 Eye & adnexa
8 Ear & mastoid
9 Circulatory
10 Respiratory
11 Digestive
12 Skin & subcutaneous
13 Musculoskeletal & connective tissue
14 Genitourinary
15 Pregnancy, childbirth & puerperium
16 Conditions originating in perinatal period
17 Congenital malformations, deformations & chromosomal abnormalities
18 Symptoms, signs & abnormal clinical & lab findings
19 Injury, poisoning & consequences of external causes
20 External causes of morbidity
21 Factors influencing health status (Lower Unspecified)
New Major Diagnosis Categories
ICD-10-CM’s new anatomic and physiologic specificity (e.g.
Glasgow Coma Score, blood types, drug underdosing and
laterality) was paralleled by an increase in unspecified codes in
all Major Diagnosis Categories except for Three
Massachusetts Case Mix Inpatient Acute Care Hospital Setting Top 10 Unspecified Poisoning Diagnoses Comparing ICD-9-CM to ICD-10-CM
Top 10 ICD-10-CM Unspecified Poisoning Diagnoses
October 2015 to September 2016Top 10 ICD-9-CM Unspecified Poisoning Diagnoses
January 2014 to September 2015
Rank ICD-9-CM Description
1 9663 Poisoning by other and unspecified anticonvulsants
2 96500 Poisoning by opium (alkaloids), unspecified
3 9779
Poisoning by unspecified drug or medicinal
substance
4 E9509
Suicide and self-inflicted poisoning by other and
unspecified solid and liquid substances
5 0059 Unspecified food poisoning
6 9729
Poisoning by other and unspecified agents primarily
affecting the cardiovascular system
7 9679 Poisoning by unspecified sedative or hypnotic
8 E9809
Poisoning by other and unspecified solid and liquid
substances, undetermined whether accidentally or
purposely inflicted
9 9659 Poisoning by unspecified analgesic and antipyretic
10 96900 Poisoning by antidepressant, unspecified
Rank ICD-10-CM Description
1 T50901A
Poisoning by unspecified drugs, medicaments and biological
substances, accidental (unintentional), initial encounter
2 T40601A
Poisoning by unspecified narcotics, accidental
(unintentional), initial encounter
3 T50902A
Poisoning by unspecified drugs, medicaments and biological
substances, intentional self-harm, initial encounter
4 T40602A
Poisoning by unspecified narcotics, intentional self-harm,
initial encounter
5 T50904A
Poisoning by unspecified drugs, medicaments and biological
substances, undetermined, initial encounter
6 T40604A
Poisoning by unspecified narcotics, undetermined, initial
encounter
7 T4271XA
Poisoning by unspecified antiepileptic and sedative-
hypnotic drugs, accidental (unintentional), initial encounter
8 T4272XA
Poisoning by unspecified antiepileptic and sedative-
hypnotic drugs, intentional self-harm, initial encounter
9 T43202A
Poisoning by unspecified antidepressants, intentional self-
harm, initial encounter
10 T4274XA
Poisoning by unspecified antiepileptic and sedative-
hypnotic drugs, undetermined, initial encounter
In ICD-9-CM (from 1/2014 to 9/2015), the code for poisoning by other and unspecified anticonvulsants ranked number one., ICD-9-CM 9663. The CMS general equivalency mapping of ICD-9-CM 9663 to maps to 16 different ICD-10-CM increased the options for poisonings by anticonvulsants
In ICD-10-CM (10/2015 to 9/2016), ICD-10-CM T50901A, unspecified medicaments and biologicals based on intentionality (accidental) and encounter sequence (initial encounter) became number one.
ICD-9-CM to ICD-10-CM General Equivalence Mapping for the Top Ranking
Inpatient Acute Care Hospital Unspecified Poisoning Diagnosis
ICD-9-CM Description ICD-10-CM Description
9963Poisoning by other and unspecified
anticonvulsants T421X1A Poisoning by iminostilbenes, accidental (unintentional), initial encounter
T421X2A Poisoning by iminostilbenes, intentional self-harm, initial encounter
T421X3A Poisoning by iminostilbenes, assault, initial encounter
T421X4A Poisoning by iminostilbenes, undetermined, initial encounter
T425X1APoisoning by mixed antiepileptics, accidental (unintentional), initial encounter
T425X2A Poisoning by mixed antiepileptics, intentional self-harm, initial encounter
T425X3A Poisoning by mixed antiepileptics, assault, initial encounter
T425X4A Poisoning by mixed antiepileptics, undetermined, initial encounter
T426X1APoisoning by other antiepileptic and sedative-hypnotic drugs, accidental (unintentional), initial encounter
T426X2APoisoning by other antiepileptic and sedative-hypnotic drugs, intentional self-harm, initial encounter
T426X3APoisoning by other antiepileptic and sedative-hypnotic drugs, assault, initial encounter
T426X4APoisoning by other antiepileptic and sedative-hypnotic drugs, undetermined, initial encounter
T4271XAPoisoning by unspecified antiepileptic and sedative-hypnotic drugs, accidental (unintentional), initial encounter
T4272XAPoisoning by unspecified antiepileptic and sedative-hypnotic drugs, intentional self-harm, initial encounter
T4273XAPoisoning by unspecified antiepileptic and sedative-hypnotic drugs, assault, initial encounter
T4274XAPoisoning by unspecified antiepileptic and sedative-hypnotic drugs, undetermined, initial encounter
The top ranking inpatient unspecified poisoning diagnosis (ICD-9-CM 9633) mapped to sixteen ICD-10-CM codes which provide new Information on anticonvulsant class, mixtures, intentionality, and episode sequence.
ICD-9-CM 9963 Crosswalk to Sixteen ICD-10-CM Codes
Within the sixteen crosswalk codes for ICD-9-CM 9963, in FY2016 ICD-10-CM T426X2A (Poisoning by other antiepileptic and sedative-hypnotic drugs, intentional self-harm, initial encounter) ranked number one providing new information on the intentional anticonvulsants for self-harm.
Massachusetts All Payer Claims Data (APCD)
ICD-10-CM coding for Trauma Patients in Prehospital Outpatient Ground and Air Ambulance Health Care Setting
Top 10 Ambulance ICD-10-CM Unspecified Traumatic Injury Diagnoses
October 2015 to September 2016
Rank ICD-10-CM Description
1 T148 Other injury of unspecified body region
2 S0990XA Unspecified injury of head, initial encounter
3 T1490 Injury, unspecified
4 S3690XA
Unspecified injury of unspecified intra-
abdominal organ, initial encounter
5 T07 Unspecified multiple injuries
6 S0190XA
Unspecified open wound of unspecified part of
head, initial encounter
7 S3982XA
Other specified injuries of lower back, initial
encounter
8 S0993XA Unspecified injury of face, initial encounter
9 S090XXA
Injury of blood vessels of head, not elsewhere
classified, initial encounter
10 S72009A
Fracture of unspecified part of neck of
unspecified femur, initial encounter for closed
fracture
Prehospital Ground and
Air Ambulance
Outpatient Emergency
Department
Inpatient Hospitalization
Post Discharge Care Settings
The APCD facilitates monitoring increased specificity in diagnosis from the prehospital to hospital care setting. ICD-10-CM T148 (Other Injury of Unspecified Body Region) was top ranking prehospital trauma diagnosis. APCD prehospital T148 trauma patients could be tracked for their prehospital diagnosis to their more specific hospital diagnosis following radiology for more specific diagnosis.
APCD allows prehospital T148 tracking across the entire spectrum of care
Top ICD-10-CM Inpatient Diagnosis for Prehospital T148 Patients
October 2015 to September 2016
Rank ICD-10-CM Full Description
1 S72142A
Displaced intertrochanteric fracture of left
femur, initial encounter for closed fracture
2 S72141A
Displaced intertrochanteric fracture of right
femur, initial encounter for closed fracture
3 S72012A
Unspecified intracapsular fracture of left femur,
initial encounter for closed fracture
4 S7222XA
Displaced subtrochanteric fracture of left femur,
initial encounter for closed fracture
5 S72002A
Fracture of unspecified part of neck of left
femur, initial encounter for closed fracture
Inpatient Diagnosis
CMS General Equivalence Mapping for a Top Ground and Air
Ambulance Inpatient Unspecified Traumatic Injury Diagnosis
ICD-9-CM Description ICD-10-CM Description
9597
Injury, other and unspecified, knee,
leg, ankle, and foot S8980XAOTHER SPECIFIED INJURIES OF UNSPECIFIED LOWER LEG, INITIAL ENCOUNTER
S8990XA UNSPECIFIED INJURY OF UNSPECIFIED LOWER LEG, INITIAL ENCOUNTER
S99819A OTHER SPECIFIED INJURIES OF UNSPECIFIED ANKLE, INITIAL ENCOUNTER
S99919A UNSPECIFIED INJURY OF UNSPECIFIED ANKLE, INITIAL ENCOUNTER
A top ranking inpatient unspecified injury diagnosis (ICD-9-CM 9597) mapped to sixteen ICD-10-CM codes which provide new Information on anticonvulsant class, mixtures, intentionality, and episode sequence.
ICD-9-CM 9597 Crosswalk to Sixteen ICD-10-CM Codes
Within the 4 crosswalk codes for ICD-9-CM 9597, in FY2016 ICD-10-CM S8980XA (Other Specified injuries of unspecified lower leg, initial encounter)ranked number one providing new information episode of care sequence and anatomic location.
CONCLUSION
• Public health researchers have historically bemoaned the quality and availability of cause data in claims-based information systems. The transition to ICD-10-CM and its increased embedding of intentionality codes demonstrates enormous benefits for public health injury surveillance.
• ICD-10-CM’s increased encoding of encounter sequence will improve the calculation of disease and injury incident rates.
• The transition from ICD-9-CM to ICD-10-CM produced a shifting in the ranking of unspecified diagnosis codes and additional unspecified codes. However, ICD-10-CM’s provision of increased anatomic and physiologic and cause specificity facilitates aligning codes with clinical facts collected from the provider’s encounter with the patient even in the outpatient ambulance setting.
