title: The discriminatory cost of ICD-10-CM transition between clinical specialties: metrics, case study, and mitigating tools.
abstract: OBJECTIVE
  Applying the science of networks to quantify the discriminatory impact of the ICD-9-CM to ICD-10-CM transition between clinical specialties.
  
  
  METHODS
  Datasets were the Center for Medicaid and Medicare Services ICD-9-CM to ICD-10-CM mapping files, general equivalence mappings, and statewide Medicaid emergency department billing. Diagnoses were represented as nodes and their mappings as directional relationships. The complex network was synthesized as an aggregate of simpler motifs and tabulation per clinical specialty.
  
  
  RESULTS
  We identified five mapping motif categories: identity, class-to-subclass, subclass-to-class, convoluted, and no mapping. Convoluted mappings indicate that multiple ICD-9-CM and ICD-10-CM codes share complex, entangled, and non-reciprocal mappings. The proportions of convoluted diagnoses mappings (36% overall) range from 5% (hematology) to 60% (obstetrics and injuries). In a case study of 24 008 patient visits in 217 emergency departments, 27% of the costs are associated with convoluted diagnoses, with 'abdominal pain' and 'gastroenteritis' accounting for approximately 3.5%.
  
  
  CONCLUSIONS
  Previous qualitative studies report that administrators and clinicians are likely to be challenged in understanding and managing their practice because of the ICD-10-CM transition. We substantiate the complexity of this transition with a thorough quantitative summary per clinical specialty, a case study, and the tools to apply this methodology easily to any clinical practice in the form of a web portal and analytic tables.
  
  
  CONCLUSIONS
  Post-transition, successful management of frequent diseases with convoluted mapping network patterns is critical. The http://lussierlab.org/transition-to-ICD10CM web portal provides insight in linking onerous diseases to the ICD-10 transition.
authors: Institute for Translational Health Informatics, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
authors: Andrew D
authors: AD
authors: Boyd
authors: Jianrong John
authors: JJ
authors: Li
authors: Mike D
authors: MD
authors: Burton
authors: Michael
authors: M
authors: Jonen
authors: Vincent
authors: V
authors: Gardeux
authors: Ikbel
authors: I
authors: Achour
authors: Roger Q
authors: RQ
authors: Luo
authors: Ilir
authors: I
authors: Zenku
authors: Neil
authors: N
authors: Bahroos
authors: Stephen B
authors: SB
authors: Brown
authors: Terry
authors: T
authors: Vanden Hoek
authors: Yves A
authors: YA
authors: Lussier
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D059019:Clinical Coding / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D038801:International Classification of Diseases / Q000191:economics / Q000458:organization & administration*; D008511:Medicine / Q000145:classification; D010346:Patient Care Management; D014481:United States
keywords: ICD-10-CM; ICD-9-CM; billing complexity; motifs; networks; transition to ICD-10-CM
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