The impact of conversion to International Classification of Diseases, 10th revision (ICD-10) on an academic ophthalmology practice

Justin B Hellman, Michele C Lim, Karen Y Leung, Cameron M Blount, Glenn Yiu Department of Ophthalmology & Vision Sciences, University of California, Davis Medical Center, Sacramento, CA, USA Purpose: To determine the financial and clinical impact of conversion from International Classifica...

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Autores principales:	Hellman JB, Lim MC, Leung KY, Blount CM, Yiu G
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	International Classification of Diseases Ophthalmology Electronic Health Records Clinical Coding Medical Records Reimbursement RE1-994
Acceso en línea:	https://doaj.org/article/6b1a1abbe46748beb71f8783504114b9
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spelling	oai:doaj.org-article:6b1a1abbe46748beb71f8783504114b92021-12-02T00:03:05ZThe impact of conversion to International Classification of Diseases, 10th revision (ICD-10) on an academic ophthalmology practice1177-5483https://doaj.org/article/6b1a1abbe46748beb71f8783504114b92018-05-01T00:00:00Zhttps://www.dovepress.com/the-impact-of-conversion-to-international-classification-of-diseases-1-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Justin B Hellman, Michele C Lim, Karen Y Leung, Cameron M Blount, Glenn Yiu Department of Ophthalmology & Vision Sciences, University of California, Davis Medical Center, Sacramento, CA, USA Purpose: To determine the financial and clinical impact of conversion from International Classification of Disease, 9th revision (ICD-9) to ICD-10 coding.Design: Retrospective, database study.Materials and methods: Monthly billing and coding data from 44,564 billable patient encounters at an academic ophthalmology practice were analyzed by subspecialty in the 1-year periods before (October 1, 2014, to September 30, 2015) and after (October 1, 2015, to September 30, 2016) conversion from ICD-9 to ICD-10.Main outcomes and measures: Primary outcome measures were payments per visit, relative value units per visit, number of visits, and percentage of high-level visits; secondary measures were denials due to coding errors, charges denied due to coding errors, and percentage of unspecified codes used as a primary diagnosis code.Results: Conversion to ICD-10 did not significantly impact payments per visit ($306.56±$56.50 vs $321.43±$38.12, P=0.42), relative value units per visit (7.15±0.56 vs 7.13±0.84, P=0.95), mean volume of visits (1,887.08±375.02 vs 1,863.83±189.81, P=0.71), or percentage of high-level visits (29.7%±4.9%, 548 of 1,881 vs 30.0%±1.7%, 558 of 1,864, P=0.81). For every 100 visits, the number of coding-related denials increased from 0.98±0.60 to 1.84±0.31 (P<0.001), and denied charges increased from $307.42±$443.39 to $660.86±$239.47 (P=0.002). The monthly percentage of unspecified codes used increased from 25.8%±1.1% (485 of 1,881) to 35.0%±2.3% (653 of 1,864, P<0.001).Conclusion: The conversion to ICD-10 did not impact overall revenue or clinical volume in this practice setting, but coding-related denials, denied charges, and the use of unspecified codes increased significantly. We expect these denials to increase in the next year in the absence of Medicare’s 1-year grace period. Keywords: ICD-10, ICD-9, ICD International Classification of Diseases, ophthalmology, electronic health records, clinical coding, medical records, reimbursementHellman JBLim MCLeung KYBlount CMYiu GDove Medical PressarticleInternational Classification of DiseasesOphthalmologyElectronic Health RecordsClinical CodingMedical RecordsReimbursementOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 12, Pp 949-956 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	International Classification of Diseases Ophthalmology Electronic Health Records Clinical Coding Medical Records Reimbursement Ophthalmology RE1-994
spellingShingle	International Classification of Diseases Ophthalmology Electronic Health Records Clinical Coding Medical Records Reimbursement Ophthalmology RE1-994 Hellman JB Lim MC Leung KY Blount CM Yiu G The impact of conversion to International Classification of Diseases, 10th revision (ICD-10) on an academic ophthalmology practice
description	Justin B Hellman, Michele C Lim, Karen Y Leung, Cameron M Blount, Glenn Yiu Department of Ophthalmology & Vision Sciences, University of California, Davis Medical Center, Sacramento, CA, USA Purpose: To determine the financial and clinical impact of conversion from International Classification of Disease, 9th revision (ICD-9) to ICD-10 coding.Design: Retrospective, database study.Materials and methods: Monthly billing and coding data from 44,564 billable patient encounters at an academic ophthalmology practice were analyzed by subspecialty in the 1-year periods before (October 1, 2014, to September 30, 2015) and after (October 1, 2015, to September 30, 2016) conversion from ICD-9 to ICD-10.Main outcomes and measures: Primary outcome measures were payments per visit, relative value units per visit, number of visits, and percentage of high-level visits; secondary measures were denials due to coding errors, charges denied due to coding errors, and percentage of unspecified codes used as a primary diagnosis code.Results: Conversion to ICD-10 did not significantly impact payments per visit ($306.56±$56.50 vs $321.43±$38.12, P=0.42), relative value units per visit (7.15±0.56 vs 7.13±0.84, P=0.95), mean volume of visits (1,887.08±375.02 vs 1,863.83±189.81, P=0.71), or percentage of high-level visits (29.7%±4.9%, 548 of 1,881 vs 30.0%±1.7%, 558 of 1,864, P=0.81). For every 100 visits, the number of coding-related denials increased from 0.98±0.60 to 1.84±0.31 (P<0.001), and denied charges increased from $307.42±$443.39 to $660.86±$239.47 (P=0.002). The monthly percentage of unspecified codes used increased from 25.8%±1.1% (485 of 1,881) to 35.0%±2.3% (653 of 1,864, P<0.001).Conclusion: The conversion to ICD-10 did not impact overall revenue or clinical volume in this practice setting, but coding-related denials, denied charges, and the use of unspecified codes increased significantly. We expect these denials to increase in the next year in the absence of Medicare’s 1-year grace period. Keywords: ICD-10, ICD-9, ICD International Classification of Diseases, ophthalmology, electronic health records, clinical coding, medical records, reimbursement
format	article
author	Hellman JB Lim MC Leung KY Blount CM Yiu G
author_facet	Hellman JB Lim MC Leung KY Blount CM Yiu G
author_sort	Hellman JB
title	The impact of conversion to International Classification of Diseases, 10th revision (ICD-10) on an academic ophthalmology practice
title_short	The impact of conversion to International Classification of Diseases, 10th revision (ICD-10) on an academic ophthalmology practice
title_full	The impact of conversion to International Classification of Diseases, 10th revision (ICD-10) on an academic ophthalmology practice
title_fullStr	The impact of conversion to International Classification of Diseases, 10th revision (ICD-10) on an academic ophthalmology practice
title_full_unstemmed	The impact of conversion to International Classification of Diseases, 10th revision (ICD-10) on an academic ophthalmology practice
title_sort	impact of conversion to international classification of diseases, 10th revision (icd-10) on an academic ophthalmology practice
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/6b1a1abbe46748beb71f8783504114b9
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The impact of conversion to International Classification of Diseases, 10th revision (ICD-10) on an academic ophthalmology practice

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