Methods Series Report #2016-02
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HCUP Methods Series Contact Information: Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality 5600 Fishers Lane Room 07W17B Mail Stop 7W25B Rockville, MD 20857 http://www.hcup-us.ahrq.gov For Technical Assistance with HCUP Products: Email: [email protected] or Phone: 1-866-290-HCUP Recommended Citation: Gibson T, Casto A, Young J, Karnell L, Coenen N. Impact of ICD-10- CM/PCS on Research Using Administrative Databases. HCUP Methods Series Report # 2016- 02 ONLINE. July 25, 2016. U.S. Agency for Healthcare Research and Quality. Available: http://www.hcup-us.ahrq.gov/reports/methods/methods.jsp. TABLE OF CONTENTS 1. EXECUTIVE SUMMARY ..................................................................................................... I 2. INTRODUCTION ................................................................................................................ 1 3. DIFFERENCES BETWEEN ICD-9-CM AND ICD-10-CM/PCS CODING SYSTEMS ........... 4 Diagnosis Coding Systems ............................................................................................. 4 Procedure Coding Systems ............................................................................................ 7 Focus Areas in the Medical and Surgical Section: Root Operations and Approaches ....10 4. LESSONS FROM DUALLY CODED DATA ........................................................................14 Differences in the ICD-9-CM and ICD-10-CM/PCS Coding Systems .............................14 Changes in Coding Rules ..............................................................................................15 Reclassification of Codes ..............................................................................................16 Coding Inconsistencies Between ICD-9-CM and ICD-10-CM/PCS ................................16 5. TOOLS TO DETERMINE CODE EQUIVALENCIES ..........................................................18 Translation Tools for Linking/Connecting ICD-9-CM and ICD-10-CM/PCS Codes .........19 General Equivalence Mappings (GEMs) ........................................................................19 Other Web-Based Tools ................................................................................................20 6. GROUPING CONDITIONS, PROCEDURES, AND COMORBIDITIES ...............................23 Assessing Sources of Information .................................................................................23 Grouping Tools for Converting ICD-10-CM/PCS Codes Into Categories ........................24 7. LONGITUDINAL ANALYSIS ..............................................................................................27 ICD-10 and Trend Analysis ............................................................................................27 Strategies ......................................................................................................................28 Comparability Ratio .......................................................................................................29 ICD-10-CM/PCS Cause of Death Transition ..................................................................30 Evidence From ICD-10 Diagnosis Codes (U.S. and International) .................................31 Other Strategies ............................................................................................................32 8. OTHER CONSIDERATIONS .............................................................................................33 Claims Payment Review Leniency Policy ......................................................................33 ICD-11 ...........................................................................................................................33 HCUP (5/20/16) Impact of ICD-10-CM/PCS 9. RESOURCES FOR RESEARCHERS ................................................................................35 Conference Proceedings and Online Webinars .............................................................35 Healthcare Cost and Utilization Project (HCUP) Software Tools ....................................35 ICD-10 Textbooks/Workbooks .......................................................................................36 ICD-10 Codebooks ........................................................................................................36 ICD-10 Software and Tools ...........................................................................................36 Peer Reviewed Journal Articles .....................................................................................37 Online Nonjournal Articles, Reports and Other Publications (From Nongovernment Agencies) ......................................................................................................................41 User Guides or Technical Reports from Government Agencies .....................................43 Working Papers .............................................................................................................45 Books ............................................................................................................................45 REFERENCES .........................................................................................................................46 APPENDIX A. MEDICAL AND SURGICAL PROCEDURE CODING: ROOT OPERATIONS AND APPROACHES ....................................................................................................................... A-1 Complete List of Root Operations ................................................................................ A-1 Complete List of Medical and Surgical Approaches ..................................................... A-6 APPENDIX B. ICD-10-PCS PROCEDURE CCS CATEGORIES THAT ARE NOT POPULATED BY ICD-10-PCS CODES ......................................................................................................... B-1 APPENDIX C. EXAMINING THE IMPACT OF ICD-10-CM/PCS IMPLEMENTATION ............. C-1 Dually Coded Discharge Dataset ................................................................................. C-1 Changes in Level of Specificity .................................................................................... C-3 Changes in Coding Rules ............................................................................................ C-8 Reclassification of Codes .......................................................................................... C-10 Coding Inconsistencies Between ICD-9-CM and ICD-10-CM/PCS ............................ C-14 Appendix References ................................................................................................ C-14 HCUP (5/20/16) Impact of ICD-10-CM/PCS INDEX OF TABLES TABLE 1. COMPARISON OF ICD-9-CM AND ICD-10-CM DIAGNOSIS CODES ...................... 5 TABLE 2. COMPARISON OF ICD-9-CM AND ICD-10-PCS PROCEDURE CODES.................. 8 TABLE 3. EXAMPLE. ICD-10-PCS 7-CHARACTER PROCEDURE CODE STRUCTURE FOR MEDICAL AND SURGICAL PROCEDURES, BREAST BIOPSY ............................................... 9 TABLE 4. EXAMPLE. ICD-10-PCS 7-CHARACTER PROCEDURE CODE STRUCTURE FOR MEDICAL AND SURGICAL PROCEDURES, RADIATION THERAPY ......................................10 TABLE 5. ICD-10-PCS ROOT OPERATION DEFINITION, EXPLANATION, AND EXAMPLES— DILATION .................................................................................................................................11 TABLE 6. COMPLETE LIST OF MEDICAL AND SURGICAL APPROACHES, FIFTH CHARACTER OF ICD-10-PCS .................................................................................................12 TABLE 7. DESCRIPTIONS FROM THE LUSSIER CONVERSION TOOLS ..............................21 TABLE 8. TOOLS FOR LINKING/CONNECTING ICD-9-CM AND ICD-10-CM/PCS CODES ...21 TABLE 9. GROUPING TOOLS FOR FINDING PATIENT COHORTS AND OTHER VARIABLES USING ICD-9-CM AND ICD-10-CM/PCS CODES ....................................................................24 INDEX OF FIGURES FIGURE 1. ICD-9-CM AND ICD-10-CM DIAGNOSIS CODING SYSTEMS ................................ 4 FIGURE 2. ICD-9-CM AND ICD-10-PCS PROCEDURE CODING SYSTEMS ........................... 7 FIGURE 3. EXAMPLE OF LONGITUDINAL CHANGE IN CODE SETS ....................................28 FIGURE 4. EXAMPLE OF COMPARABILITY RATIO ADJUSTMENT FROM ICD-10-CM/PCS TO ICD-9-CM CODES IN A LONGITUDINAL ANALYSIS .........................................................30 HCUP (5/20/16) Impact of ICD-10-CM/PCS 1. EXECUTIVE SUMMARY In October 2015 the United States transitioned to a modified version of the World Health Organization (WHO) International Classification of Diseases (ICD-10-CM/PCS), replacing the ICD-9-CM diagnosis and procedure coding system with the ICD-10-CM diagnosis coding system for most inpatient and outpatient medical encounters and the ICD-10-PCS procedure coding system for inpatient hospital procedures. This transition is expected to have a profound and direct impact on reimbursement and the delivery of medical care. However, health care researchers are expected to be affected by this transition when administrative databases become available with ICD-10-CM/PCS codes. This document is intended to summarize many of the main issues encountered by researchers when transitioning to the ICD-10-CM/PCS coding system, and summarizes tools and resources available to assist researchers with this transition. Differences Between ICD-9-CM and ICD-10-CM/PCS Coding Systems Researchers will have many more clinical codes to reference when using ICD-10-CM/PCS