Providers could lose Medicaid money and patient information due to ICD-10 transition, researchers find

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Healthcare providers could experience financial and information losses when they make the mandated transition to the new International Classification of Diseases coding system in October, according to researchers at the University of Illinois-Chicago. 

The investigators analyzed how the switch from ICD-9 to ICD-10 is likely to affect hematology-oncology diagnoses. Prior research showed that this sub-specialty has fewer codes than others and so will have a relatively simple transition, the research team noted. Their findings reveal challenges that “all providers may face,” they stated.

The UIC team focused on outpatient codes associated with hematology-oncology diagnoses in 2010, pulled from databases kept by the Illinois Medicaid program and the University of Illinois Cancer Center. Using a specially devised Web-based tool, the team translated the current ICD-9 codes to ICD-10. This resulted in “significant information loss,” they discovered.

In terms of financial implications, 39 ICD-9 Medicaid codes flagged for information loss accounted for nearly 3% of the doctors' total Medicaid reimbursements and more than 5% of the cancer center's billings, the researchers determined.

Part of the problem is that the code translation system from the Centers for Medicare & Medicaid Services is “complex and difficult,” the investigators noted. Their findings appear in the March issue of the Journal of Oncology Practice.

The number of codes will jump from about 14,000 under the current system to more than 68,000. Healthcare providers have lobbied for additional time to make the transition, but CMS recently confirmed that the Oct. 1 date will stand.

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