title: The transition to ICD-10-CM: challenges for pediatric practice.
abstract: OBJECTIVE
  Diagnostic codes are used widely within health care for billing, quality assessment, and to measure clinical outcomes. The US health care system will transition to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), in October 2015. Little is known about how this transition will affect pediatric practices. The objective of this study was to examine how the transition to ICD-10-CM may result in ambiguity of clinical information and financial disruption for pediatricians.
  
  
  METHODS
  Using a statewide data set from Illinois Medicaid specified for pediatricians, 2708 International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis codes were identified. Diagnosis codes were categorized into 1 of 5 categories: identity, class-to-subclass, subclass-to-class, convoluted, and no translation. The convoluted and high-cost diagnostic codes (n = 636) were analyzed for accuracy and categorized into "information loss," "overlapping categories," "inconsistent," and "consistent." Finally, reimbursement by Medicaid was calculated for each category.
  
  
  RESULTS
  Twenty-six percent of pediatric diagnosis codes are convoluted, which represents 21% of Illinois Medicaid pediatric patient encounters and 16% of reimbursement. The diagnosis codes represented by information loss (3.6%), overlapping categories (3.2%), and inconsistent (1.2%) represent 8% of Medicaid pediatric reimbursement.
  
  
  CONCLUSIONS
  The potential for financial disruption and administrative errors from 8% of reimbursement diagnosis codes necessitates special attention to these codes in preparing for the transition to ICD-10-CM for pediatric practices.
authors.affiliation: Departments of Pediatrics,Internal Medicine, and boyda@uic.edu rcaskey@uic.edu.
authors.forename: Rachel
authors.initials: R
authors.lastname: Caskey
authors.affiliation: Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois;
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Zaman
authors.affiliation: Departments of Pediatrics.
authors.forename: Hannah
authors.initials: H
authors.lastname: Nam
authors.affiliation: Departments of Pediatrics.
authors.forename: Sae-Rom
authors.initials: SR
authors.lastname: Chae
authors.affiliation: Department of Pediatrics, Medstar Southern Maryland Hospital Center, Clinton, Maryland;
authors.forename: Lauren
authors.initials: L
authors.lastname: Williams
authors.affiliation: Alexian Brothers Health System, Chicago, Illinois; and.
authors.forename: Gina
authors.initials: G
authors.lastname: Mathew
authors.affiliation: Internal Medicine, and.
authors.forename: Michael
authors.initials: M
authors.lastname: Burton
authors.affiliation: Department of Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Jiarong John
authors.initials: JJ
authors.lastname: Li
authors.affiliation: Department of Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Yves A
authors.initials: YA
authors.lastname: Lussier
authors.affiliation: Internal Medicine, andBiomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois; boyda@uic.edu rcaskey@uic.edu.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Boyd
mesh_terms: D007087:Illinois; D038801:International Classification of Diseases; D008484:Medicaid; D010372:Pediatrics; D012051:Reimbursement Mechanisms; D014481:United States
keywords: ICD-10-CM; ICD-9-CM; convolution; diagnostic codes; health informatics