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Problems and Barriers in the Transition to ICD-10-CM/PCS: A Qualitative Study of Medical Coders’ Perceptions

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Book cover New Knowledge in Information Systems and Technologies (WorldCIST'19 2019)

Part of the book series: Advances in Intelligent Systems and Computing ((AISC,volume 932))

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Abstract

Background. Clinical coding is the process of transforming the information about diseases or procedures recorded in the health records, into numeric or alphanumeric codes, using an international classification system. Recently, a new version of the classification system (ICD-10-CM/PCS) started being used in Portugal.

Objective. To explore the perceptions of medical coders (medical doctors) regarding problems related to the transition from ICD-9-CM to ICD-10-CM/PCS that may affect the quality of coded data.

Methods. A qualitative study using four focus groups sessions with ten medical coders was performed between October and November 2017. The convenience sample was obtained from four public hospitals in Portugal. Questions related to problems with the coding process were developed by reviewing literature and with authors’ expertise. The focus groups sessions were taped, transcribed and analyzed to elicit themes.

Results. Several problems related to the classification system transition were identified by the medical coders: more time spent in coding, decreased productivity, lack of clinical coding audits and lack of consensus and guidelines.

Conclusion. The availability of more tools to help medical coders, the establishment of guidelines and consensus, and clinical coding audits could increase the quality of coded data, contributing to achieve the expected improvements with the introduction of ICD-10-CM/PCS, namely in the purposes it is collected for.

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References

  1. Topaz, M., Shafran-Topaz, L., Bowles, K.H.: ICD-9 to ICD-10: evolution, revolution, and current debates in the United States. Perspect. Health Inf. Manag. 10(Spring), 1d (2013)

    Google Scholar 

  2. Manchikanti, L., Falco, F.J.E., Hirsch, J.A.: Necessity and implications of ICD-10: facts and fallacies. Pain Physician 14(5), E405–E425 (2011)

    Google Scholar 

  3. Jetté, N., Quan, H., Hemmelgarn, B., Drosler, S., Maass, C., Moskal, L., et al.: The development, evolution, and modifications of ICD-10: challenges to the international comparability of morbidity data. Med. Care 48(12), 1105–1110 (2010)

    Article  Google Scholar 

  4. Hazlewood, A.: ICD-9 CM to ICD-10 CM: implementation issues and challenges. In: AHIMA’s 75th Anniversary National Convention and Exhibit Proceedings (2003)

    Google Scholar 

  5. ACSS: Implementação do Sistema de Codificação Clínica ICD-10-CM/PCS em Portugal, em substituição da atual ICD-9-CM. http://www.acss.min-saude.pt//wp-content/uploads/2016/07/Perguntas-Frequentes_-ICD10CMPCS.pdf. Accessed 28 July 2017

  6. Butz, J., Brick, D., Rinehart-Thompson, L.A., Brodnik, M., Agnew, A.M., Patterson, E.S.: Differences in coder and physician perspectives on the transition to ICD-10-CM/PCS: a survey study. Health Policy Technol. 5(3), 251–259 (2016)

    Article  Google Scholar 

  7. Sand, J.N., Elison-Bowers, P.: ICD-10-CM/PCS: transferring knowledge from ICD-9-CM. Perspect. Health Inf. Manag. 10(Summer), 1g (2013)

    Google Scholar 

  8. ACSS: Grupos de Diagnósticos Homogéneos. http://www2.acss.min-saude.pt/Default.aspx?TabId=460&language=pt-PT. Accessed 13 Aug 2017

  9. Watzlaf, V., Alkarwi, Z., Meyers, S., Sheridan, P.: Physicians’ outlook on ICD-10-CM/PCS and its effect on their practice. Perspect. Health Inf. Manag. 12, 1b (2015)

    Google Scholar 

  10. Rousse, J.T.: From novice to expert: problem solving in ICD-10-PCS procedural coding. Perspect. Health Inf. Manag. 10(Summer), 1d (2013)

    Google Scholar 

  11. Wright, R.E.: Administrative simplification: change to the compliance date for the international classification of diseases, 10th revision (ICD–10–CM and ICD–10–PCS) medical data code sets. Fed. Reg. 79(149), 45128–45134 (2014)

    Google Scholar 

  12. Sanders, T.B., Bowens, F.M., Pierce, W., Stasher-Booker, B., Thompson, E.Q., Jones, W.A.: The road to ICD-10-CM/PCS implementation: forecasting the transition for providers, payers, and other healthcare organizations. Perspect. Health Inf. Manag. 9(Winter), 1f (2012)

    Google Scholar 

  13. Mills, R.E., Butler, R.R., McCullough, E.C., Bao, M.Z., Averill, R.F.: Impact of the transition to ICD-10 on Medicare Inpatient Hospital Payments. Medicare Medicaid Res. Rev. 1(2) (2011)

    Google Scholar 

  14. Freitas, A., Lema, I., da Costa-Pereira, A.: Comorbidity coding trends in hospital administrative databases. In: Rocha, Á., Correia, A., Adeli, H., Reis, L., Mendonça Teixeira, M. (eds.) New Advances in Information Systems and Technologies. Advances in Intelligent Systems and Computing, vol. 445. Springer, Cham (2016)

    Chapter  Google Scholar 

  15. Stanfill, M.H., Kang, L., Hsieh, K., Beal, R., Fenton, S.H.: Preparing for ICD-10-CM/PCS implementation: impact on productivity and quality. Perspect. Health Inf. Manag. 11, 1f (2014)

    Google Scholar 

  16. Pongpirul, K., Walker, D.G., Rahman, H., Robinson, C.: DRG coding practice: a nationwide hospital survey in Thailand. BMC Health Serv. Res. 11, 290 (2011)

    Article  Google Scholar 

  17. Alakrawi, Z.M., Nemchik, S., Sheridan, P.T.: New study illuminates the ongoing road to ICD-10 productivity and optimization. J. AHIMA 88(3), 40–45 (2017)

    Google Scholar 

  18. INE: Portal do Instituto Nacional de Estatística. https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_indicadores&indOcorrCod=0008121&contexto=bd&selTab=tab2. Accessed 4 Oct 2018

  19. Bardin, L.: Análise de Conteúdo. 4 edicao. EDICOES, Lisboa, 70 (2011)

    Google Scholar 

  20. Ngene, N.C., Moodley, J.: Assigning appropriate and comprehensive diagnosis for scientific report. Med. Hypotheses 83(6), 681–684 (2014)

    Article  Google Scholar 

  21. Lucyk, K., Tang, K., Quan, H.: Barriers to data quality resulting from the process of coding health information to administrative data: a qualitative study. BMC Health Serv. Res. 17(1), 766 (2017)

    Article  Google Scholar 

  22. Houser, S.H., Hart-Hester, S.: Assessing the planning and implementation strategies for the ICD-10-CM/PCS coding transition in Alabama hospitals. Perspect. Health Inf. Manag. 10, 1a (2013)

    Google Scholar 

  23. Manchikanti, L., Falco, F.J.E., Kaye, A.D., Hirsch, J.A.: The disastrous but preventable consequences of ICD-10. Pain Physician 17(2), E111–E118 (2014)

    Google Scholar 

  24. Meyer, H.: Coding complexity: us health care gets ready for the coming of ICD-10. Health Aff. 30(5), 968–974 (2011)

    Article  Google Scholar 

  25. Ross-davis, S.V.: Preparing for ICD-10-CM/PCS: one payer’s experience with General Equivalence Mappings (GEMs). Perspect. Health Inf. Manag. 9(Winter), 1e (2012)

    Google Scholar 

  26. Libicki, M., Brahmakulam, I.: The Costs and Benefits of Moving to the ICD-10 Code Sets. RAND Corporation, Santa Monica (2004). https://www.rand.org/pubs/technical_reports/TR132.html

    Google Scholar 

  27. Office of the Secretary, HHS: HIPAA administrative simplification: modifications to medical data code set standards to adopt ICD-10-CM and ICD-10-PCS. Fed. Reg. 74(11), 3328–3362 (2009)

    Google Scholar 

  28. DeAlmeida, D.R., Watzlaf, V.J., Anania-Firouzan, P., Salguero, O., Rubinstein, E., Abdelhak, M., et al.: Evaluation of inpatient clinical documentation readiness for ICD-10-CM. Perspect. Health Inf. Manag. 11(Winter), 1h (2014)

    Google Scholar 

  29. Cartwright, D.J.: ICD-9-CM to ICD-10-CM codes: What? Why? How? Adv. Wound Care (New Rochelle) 2(10), 588–592 (2013)

    Article  Google Scholar 

  30. Kealey, B.Y.B., Howie, A.: ICD-10 is coming an update on medical diagnosis and inpatient procedure coding. Minn. Med. 96(11), 48–50 (2013)

    Google Scholar 

  31. Barta, A., McNeill, G.C., Meli, P.L., Wall, K.E., Zeisset, A.M.: ICD-10-CM primer. J. AHIMA 79(5), 64–66 (2008)

    Google Scholar 

  32. Chute, C.G., Huff, S.M., Ferguson, J.A., Walker, J.M., Halamka, J.D.: There are important reasons for delaying implementation of the new ICD-10 coding system. Health Aff. 31(4), 836–842 (2012)

    Article  Google Scholar 

  33. Carpentier, P.J.: The risk of getting paid: why ICD-10-CM may increase physician liability under the False Claims Act. Quinnipiac Health Law J. 16, 117–148 (2013)

    Google Scholar 

  34. Tatham, A.: The increasing importance of clinical coding. Br. J. Hosp. Med. 69(7), 372–373 (2008)

    Article  Google Scholar 

  35. Naran, S., Hudovsky, A., Antscherl, J., Howells, S., Nouraei, S.A.R.: Audit of accuracy of clinical coding in oral surgery. Br. J. Oral Maxillofac. Surg. 52(8), 735–739 (2014)

    Article  Google Scholar 

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Acknowledgments

The authors would like to thank the focus group participants, the MSc in Medical Informatics (http://mim.med.up.pt), and Project NanoSTIMA (NORTE-01-0145-FEDER-000016). Project NanoSTIMA is financed by the North Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, and through the European Regional Development Fund (ERDF).

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Authors and Affiliations

  1. Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal

    Vera Alonso, João Vasco Santos, Joana Ferreira, Isabel Lema, Fernando Lopes & Alberto Freitas

  2. CINTESIS – Center for Health Technology and Services Research, Porto, Portugal

    Vera Alonso, João Vasco Santos, Marta Pinto, Joana Ferreira, Isabel Lema, Fernando Lopes & Alberto Freitas

  3. Public Health Unit, ACeS Grande Porto VIII Espinho-Gaia, Vila Nova de Gaia, Portugal

    João Vasco Santos

  4. Faculty of Psychology and Education Science, University of Porto, Porto, Portugal

    Marta Pinto

  5. Subgroup of Terrorism and Security of the Crime and Justice Group of Campbell Collaboration, Brisbane, Australia

    Marta Pinto

Authors
  1. Vera Alonso
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  2. João Vasco Santos
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  3. Marta Pinto
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  4. Joana Ferreira
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  5. Isabel Lema
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  6. Fernando Lopes
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  7. Alberto Freitas
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Corresponding author

Correspondence to Vera Alonso .

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Editors and Affiliations

  1. Departamento de Engenharia Informática, Universidade de Coimbra, Coimbra, Portugal

    Álvaro Rocha

  2. The Ohio State University, Columbus, OH, USA

    Hojjat Adeli

  3. Faculdade de Engenharia/LIACC, Universidade do Porto, Porto, Portugal

    Luís Paulo Reis

  4. DIMES, Università della Calabria, Arcavacata di Rende, Italy

    Sandra Costanzo

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Alonso, V. et al. (2019). Problems and Barriers in the Transition to ICD-10-CM/PCS: A Qualitative Study of Medical Coders’ Perceptions. In: Rocha, Á., Adeli, H., Reis, L., Costanzo, S. (eds) New Knowledge in Information Systems and Technologies. WorldCIST'19 2019. Advances in Intelligent Systems and Computing, vol 932. Springer, Cham. https://doi.org/10.1007/978-3-030-16187-3_8

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