Fleming Margaret, MacFarlane Dan, Torres William E, Duszak Richard
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
J Am Coll Radiol. 2015 Nov;12(11):1155-61. doi: 10.1016/j.jacr.2015.06.014. Epub 2015 Jul 26.
Converting the nation's International Classification of Diseases (ICD) diagnosis coding system, from 14,025 ICD-9 to 69,823 ICD-10 codes, is projected to have enormous financial and operational implications. We aimed to assess the magnitude of impact that this code conversion will have on radiology claims.
The most frequently billed ICD-9 diagnosis codes for 588,523 radiology claims from five hospitals and affiliated outpatient sites during a 12-month period were mapped to matching ICD-10 codes using a Medicare-endorsed tool. The code-conversion impact factor was calculated for the entire radiology system, and each individual subspecialty division.
Of all ICD-9 codes, only 3,407 (24.3%) were used to report any primary diagnosis. Of all claims, 50% were billed using just 37 (0.3%) primary codes; 75% with 131 (0.5%), and 90% with 348 (2.5%). Those 348 ICD-9 codes mapped onto 2,048 ICD-10 codes (5.9-fold impact), representing just 2.9% of all ICD-10 codes. By subspecialty, the conversion impact factor varied greatly, from 1.1 for breast (11 ICD-9 to 12 ICD-10 codes) to 28.8 for musculoskeletal imaging (146 to 4,199). The community division, reflecting a general practice mix, saw a conversion impact factor of 5.8 (254 to 1,471).
Fewer than 3% of all ICD-9 and ICD-10 codes are used to report an overwhelming majority of all radiology claims. Although the number of commonly used codes will expand 5.9-fold overall, musculoskeletal imaging will experience a projected 28.8-fold explosion. Radiology practices should target their ICD educational and operational conversion efforts in an evidence-based manner.
将美国国家疾病分类（ICD）诊断编码系统从14,025个ICD - 9编码转换为69,823个ICD - 10编码，预计会产生巨大的财务和运营影响。我们旨在评估此次编码转换对放射学索赔的影响程度。
使用医疗保险认可的工具，将五家医院及其附属门诊在12个月期间的588,523份放射学索赔中最常计费的ICD - 9诊断编码映射到匹配的ICD - 10编码。计算整个放射学系统以及每个单独亚专业部门的编码转换影响因子。
在所有ICD - 9编码中，仅3,407个（24.3%）用于报告任何主要诊断。在所有索赔中，50%仅使用37个（0.3%）主要编码计费；75%使用131个（0.5%），90%使用348个（2.5%）。这348个ICD - 9编码映射到2,048个ICD - 10编码（5.9倍的影响），仅占所有ICD - 10编码的2.9%。按亚专业划分，转换影响因子差异很大，从乳腺的1.1（11个ICD - 9编码到12个ICD - 10编码）到肌肉骨骼成像的28.8（146个到4,199个）。反映一般业务组合的社区部门的转换影响因子为5.8（254个到1,471个）。
所有放射学索赔中的绝大多数仅使用不到3%的ICD - 9和ICD - 10编码报告。虽然常用编码数量总体上将扩大5.9倍，但肌肉骨骼成像预计将出现28.8倍的激增。放射学实践应以循证方式针对其ICD教育和运营转换工作。
