J Am Med Inform Assoc - The discriminatory cost of ICD-10-CM transition between clinical specialties: metrics, case study, and mitigating tools.

Tópicos

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Resumo

JECTIVE: Applying the science of networks to quantify the discriminatory impact of the ICD-9-CM to ICD-10-CM transition between clinical specialties.MATERIALS AND METHODS: Datasets were the Center for Medicaid and Medicare Services ICD-9-CM to ICD-10-CM mapping files, general equivalence mappings, and statewide Medicaid emergency department billing. Diagnoses were represented as nodes and their mappings as directional relationships. The complex network was synthesized as an aggregate of simpler motifs and tabulation per clinical specialty.RESULTS: We identified five mapping motif categories: identity, class-to-subclass, subclass-to-class, convoluted, and no mapping. Convoluted mappings indicate that multiple ICD-9-CM and ICD-10-CM codes share complex, entangled, and non-reciprocal mappings. The proportions of convoluted diagnoses mappings (36% overall) range from 5% (hematology) to 60% (obstetrics and injuries). In a case study of 24 008 patient visits in 217 emergency departments, 27% of the costs are associated with convoluted diagnoses, with 'abdominal pain' and 'gastroenteritis' accounting for approximately 3.5%.DISCUSSION: Previous qualitative studies report that administrators and clinicians are likely to be challenged in understanding and managing their practice because of the ICD-10-CM transition. We substantiate the complexity of this transition with a thorough quantitative summary per clinical specialty, a case study, and the tools to apply this methodology easily to any clinical practice in the form of a web portal and analytic tables.CONCLUSIONS: Post-transition, successful management of frequent diseases with convoluted mapping network patterns is critical. The http://lussierlab.org/transition-to-ICD10CM web portal provides insight in linking onerous diseases to the ICD-10 transition.

Resumo Limpo

jectiv appli scienc network quantifi discriminatori impact icdcm icdcm transit clinic specialtiesmateri method dataset center medicaid medicar servic icdcm icdcm map file general equival map statewid medicaid emerg depart bill diagnos repres node map direct relationship complex network synthes aggreg simpler motif tabul per clinic specialtyresult identifi five map motif categori ident classtosubclass subclasstoclass convolut map convolut map indic multipl icdcm icdcm code share complex entangl nonreciproc map proport convolut diagnos map overal rang hematolog obstetr injuri case studi patient visit emerg depart cost associ convolut diagnos abdomin pain gastroenter account approxim discuss previous qualit studi report administr clinician like challeng understand manag practic icdcm transit substanti complex transit thorough quantit summari per clinic specialti case studi tool appli methodolog easili clinic practic form web portal analyt tablesconclus posttransit success manag frequent diseas convolut map network pattern critic httplussierlaborgtransitiontoicdcm web portal provid insight link oner diseas icd transit

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