alexa Implications of Conversion to ICD-1-CM on Trauma Coding and Reimbursement: A Brief Report by the AAST Committee on Coding and Reimbursement | Open Access Journals
ISSN: 2167-1222
Journal of Trauma & Treatment
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Implications of Conversion to ICD-1-CM on Trauma Coding and Reimbursement: A Brief Report by the AAST Committee on Coding and Reimbursement

Peter Jenkins*, Miller P, Shafi S, Utter G, Fakhry S, Claridge J, Diaz J and Reed RL

Department of Surgery, Indiana University, Indianapolis, USA

*Corresponding Author:
Peter Jenkins
Department of Surgery, Indiana University
Indianapolis, USA
Tel: (317)962-5339
Fax: (317)962-2082
E-mail:pjenkins1@IUHealth.org

Received date: January 11, 2017; Accepted date: February 04, 2017; Published date: February 07, 2017

Citation: Jenkins P, Miller P, Shafi S, Utter G, Fakhry S, et al. (2017) Implications of Conversion to ICD-10-CM on Trauma Coding and Reimbursement: A Report from the AAST Committee on Coding and Reimbursement . J Trauma Treat 6:356. doi:10.4172/2167-1222.1000356

Copyright: © 2017 Jenkins P, et al. This is an open-access article distributed under the terms of the creative commons attribution license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Trauma & Treatment

Keywords

ICD-10-CM; Trauma; Coding

Introduction

On October 1, 2015, physicians and hospitals in the United States were required the Centers for Medicaid and Medicare Services (CMS) to begin using ICD-10-CM codes for reimbursement, replacing the 20- year-old ICD-9-CM system. We hypothesized that changes to coding complexity could affect reimbursement processes for trauma centers and trauma surgeons. To quantify this potential challenge, we examined the change in complexity of trauma-related ICD-10-CM codes in comparison to other disease categories.

Method

ICD-9-CM and ICD-10-CM codes and descriptions were downloaded from the Centers for Disease Control and Prevention’s website, as well as general equivalency mapping tables between the two coding systems. These data elements were imported into a Microsoft Access database for analysis using sequential queries. ICD-9-CM and ICD-10-CM codes were then organized and quantified by disease category.

In comparison to the 14,567 diagnostic codes comprising ICD-9- CM, the fully configured ICD-10-CM code-set has 91,737 diagnostic codes, an increase of 630%. The ICD-10-CM system is sectioned into 21 disease categories (Figure 1). In ICD-9-CM, the Injury & Poisoning category comprised 17.8% of the available codes, whereas that category comprises 58.4% of the total codes in ICD-10-CM. When the injuryrelated codes themselves (n= 42,675) are separated from the poisoning codes (n= 9,728), but combined with the external causes related to injury (n= 9,245), the trauma-related codes total 51,920, or 57.8% of the total.

trauma-treatment-Codes-Disease-Category

Figure 1: Number and Percentage of ICD-10-CM Codes by Disease Category.

Much of the increased code volume is due to replicative codes concerning the episode of care (“initial”, “subsequent”, or “sequela”) and laterality (“right” or “left”). There are 35,775 codes in all of ICD-10 that include episode of care determinations, of which 28,830 (80.6%) are trauma-related. Similarly, there are 29,918 codes that require a laterality determination, of which 23,660 (79%) are trauma-related.

Discussion and Conclusion

ICD-10-CM represents a massive expansion in diagnostic codes for billing and reimbursement. The largest increase occurs in codes related to trauma, which places a disproportionate documentation burden on trauma surgeons compared to other physicians.

For example, there are 1,003 ICD-10-CM codes for trauma to the lower limbs. Focusing just on the codes for fractures of the left femur, there are 63 separate codes, differing in the type of fracture (“Salter- Harris Type I,” “Salter-Harris Type II,” “Salter-Harris Type III,” “Salter- Harris Type IV,” “Other,” or “Unspecified”); fracture location (“upper end” or “lower end”); episode of care (“initial,” “subsequent,” and “sequela”); and nature of healing (“routine healing,” “delayed healing,” “non-union,” and “malunion”). In addition, there are 63 codes differentiated along the same criteria for right femur fractures. Thus, there are 126 different codes for femur fractures. (It is difficult to believe these all represent different diseases.) In contrast, there are only 3 codes for malignant neoplasms of the femur differing in side (“right”, “left”, or “unspecified”).

Thus, the various tumor types (i.e., osteosarcoma, chondrosarcoma, etc.), their grades, stages, and episodes of care are not captured at all. Thus the ICD-10 taxonomy appears to consider a right femur fracture to be a different disease than a left femur fracture, because they have separate and specific disease code. But a low-grade right femur osteosarcoma stage I is considered to be the same disease as a highgrade right femur chondrosarcoma stage IV, because they share the same code. Such examples of the disproportionate complexity of injury coding call into question the clinical relevance and research benefit of the conversion to ICD-10-CM coding.

The impact of the conversion to ICD-10-CM coding on physician and hospital reimbursement is unclear thus far, because CMS has only recently (October 2016) begun to deny claims based on the expanded ICD-10-CM codes. However, to be successful in receiving legitimate reimbursement for procedures and services, it appears that trauma surgeons, in particular, will need to acquire a solid working knowledge of the ICD-10-CM code set and the available look-up tools. Furthermore, trauma centers should be prepared to provide support with coding, given the risk to hospital reimbursement. Future studies should examine rates of denial of claims among different fields of medicine to assess the financial burden of this change in CMS policy.

Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Relevant Topics

Recommended Conferences

Article Usage

  • Total views: 394
  • [From(publication date):
    March-2017 - Aug 20, 2017]
  • Breakdown by view type
  • HTML page views : 363
  • PDF downloads :31
 
 

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

agrifoodaquavet@omicsonline.com

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

clinical_biochem@omicsonline.com

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

business@omicsonline.com

1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

chemicaleng_chemistry@omicsonline.com

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

environmentalsci@omicsonline.com

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

engineering@omicsonline.com

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

generalsci_healthcare@omicsonline.com

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

genetics_molbio@omicsonline.com

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

immuno_microbio@omicsonline.com

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

omics@omicsonline.com

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

materialsci@omicsonline.com

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

mathematics_physics@omicsonline.com

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

medical@omicsonline.com

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

neuro_psychology@omicsonline.com

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

pharma@omicsonline.com

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

social_politicalsci@omicsonline.com

1-702-714-7001 Extn: 9042

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version