title: Simulation of ICD-9 to ICD-10-CM Transition for Family Medicine: Simple or Convoluted?
abstract: OBJECTIVE
  The objective of this study was to examine the impact of the transition from International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), to Interactional Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), on family medicine and to identify areas where additional training might be required.
  
  
  METHODS
  Family medicine ICD-9-CM codes were obtained from an Illinois Medicaid data set (113,000 patient visits and $5.5 million in claims). Using the science of networks, we evaluated each ICD-9-CM code used by family medicine physicians to determine whether the transition was simple or convoluted. A simple transition is defined as 1 ICD-9-CM code mapping to 1 ICD-10-CM code, or 1 ICD-9-CM code mapping to multiple ICD-10-CM codes. A convoluted transition is where the transitions between coding systems is nonreciprocal and complex, with multiple codes for which definitions become intertwined. Three family medicine physicians evaluated the most frequently encountered complex mappings for clinical accuracy.
  
  
  RESULTS
  Of the 1635 diagnosis codes used by family medicine physicians, 70% of the codes were categorized as simple, 27% of codes were convoluted, and 3% had no mapping. For the visits, 75%, 24%, and 1% corresponded with simple, convoluted, and no mapping, respectively. Payment for submitted claims was similarly aligned. Of the frequently encountered convoluted codes, 3 diagnosis codes were clinically incorrect, but they represent only <0.1% of the overall diagnosis codes.
  
  
  CONCLUSIONS
  The transition to ICD-10-CM is simple for 70% or more of diagnosis codes, visits, and reimbursement for a family medicine physician. However, some frequently used codes for disease management are convoluted and incorrect, and for which additional resources need to be invested to ensure a successful transition to ICD-10-CM.
authors.affiliation: From the Departments of Family Medicine (SNG), Biomedical and Health Information Sciences (JP, ADB), and General Internal Medicine (MB), University of Illinois, Chicago; and the Department of Medicine, University of Arizona (YAL, JL).
authors.forename: Samuel N
authors.initials: SN
authors.lastname: Grief
authors.affiliation: From the Departments of Family Medicine (SNG), Biomedical and Health Information Sciences (JP, ADB), and General Internal Medicine (MB), University of Illinois, Chicago; and the Department of Medicine, University of Arizona (YAL, JL).
authors.forename: Jesal
authors.initials: J
authors.lastname: Patel
authors.affiliation: From the Departments of Family Medicine (SNG), Biomedical and Health Information Sciences (JP, ADB), and General Internal Medicine (MB), University of Illinois, Chicago; and the Department of Medicine, University of Arizona (YAL, JL).
authors.forename: Karl M
authors.initials: KM
authors.lastname: Kochendorfer
authors.affiliation: From the Departments of Family Medicine (SNG), Biomedical and Health Information Sciences (JP, ADB), and General Internal Medicine (MB), University of Illinois, Chicago; and the Department of Medicine, University of Arizona (YAL, JL).
authors.forename: Lee A
authors.initials: LA
authors.lastname: Green
authors.affiliation: From the Departments of Family Medicine (SNG), Biomedical and Health Information Sciences (JP, ADB), and General Internal Medicine (MB), University of Illinois, Chicago; and the Department of Medicine, University of Arizona (YAL, JL).
authors.forename: Yves A
authors.initials: YA
authors.lastname: Lussier
authors.affiliation: From the Departments of Family Medicine (SNG), Biomedical and Health Information Sciences (JP, ADB), and General Internal Medicine (MB), University of Illinois, Chicago; and the Department of Medicine, University of Arizona (YAL, JL).
authors.forename: Jianrong
authors.initials: J
authors.lastname: Li
authors.affiliation: From the Departments of Family Medicine (SNG), Biomedical and Health Information Sciences (JP, ADB), and General Internal Medicine (MB), University of Illinois, Chicago; and the Department of Medicine, University of Arizona (YAL, JL).
authors.forename: Michael
authors.initials: M
authors.lastname: Burton
authors.affiliation: From the Departments of Family Medicine (SNG), Biomedical and Health Information Sciences (JP, ADB), and General Internal Medicine (MB), University of Illinois, Chicago; and the Department of Medicine, University of Arizona (YAL, JL). boyda@uic.edu.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Boyd
mesh_terms: D059019:Clinical Coding / Q000145:classification* / Q000191:economics; D003198:Computer Simulation; D003365:Costs and Cost Analysis; D057286:Electronic Health Records / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D005194:Family Practice / Q000145:classification* / Q000191:economics; D006801:Humans; D007087:Illinois; D007345:Insurance Claim Review / Q000191:economics / Q000706:statistics & numerical data; D038801:International Classification of Diseases / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D008491:Medical Informatics Applications; D012051:Reimbursement Mechanisms / Q000191:economics / Q000592:standards; D014481:United States
keywords: Clinical Coding; Electronic Medical Records; Family Practice; Medical Informatics