COMPARISON OF ICD-9-CM TO ICD-10-CM CROSSWALKS DERIVED BY PHYSICIAN AND CLINICAL CODER VS. AUTOMATED METHODS

• Published in: Perspectives in health information management Vol. 18; no. Spring; pp. 1 - 8
• Main Authors: Simeone, Jason C, Liu, Xinyue, Bhagnani, Tarun, Reynolds, Matthew W, Collins, Jenna, Bortnichak, Edward A
• Format: Journal Article
• Language: English
• Published: Chicago American Health Information Management Association 01.04.2021
• Subjects: Algorithms; Automation; Cardiac arrhythmia; Codes; Cognitive ability; Diabetes; Diabetic neuropathy; Diabetic retinopathy; Disease; Heart attacks; Heart failure; Hypertension; Hypoglycemia; Sensitivity analysis; Software
• ISSN: 1559-4122; 1559-4122

Introduction Observational studies of administrative claims or electronic medical record (EMR) data frequently require the use of coding algorithms to identify patients with a particular comorbidity or outcome of interest.1 The coding algorithms developed in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding system are now obsolete when analyzing contemporary data. The United States Department of Health & Human Services required providers to switch from diagnosing medical conditions with the ICD-9-CM to the ICD-10th Revision, Clinical Modification (ICD-10-CM) by October 1, 2015.2 This transition necessitated a "crosswalk" of existing ICD-9-CM coding algorithms to the ICD-10-CM system. The Centers for Medicare & Medicaid Services (CMS) published the GEMs as a software tool to facilitate this process, with the goal of allowing medical professionals, researchers, and others to identify ICD-9-CM to ICD-10-CM coding crosswalks.3 The GEMs are a comprehensive translation tool used to convert diagnosis and procedure codes from one ICD coding system to the other.4 These crosswalks assist healthcare professionals, researchers, and administrative staff by linking codes for data used for billing, tracking quaUty, recording morbidity/mortality, calculating reimbursement, and converting any ICD-9-CM-based application to ICD-10-CM/Procedural Classification System.4 There are two types of GEMs tools, which are directional. Existing ICD-9-CM algorithms were compiled and evaluated by the study authors for the following 10 clinical conditions: acute myocardial infarction (AMI), cardiac arrhythmia, chronic kidney disease (CKD), congestive heart failure (CHF), diabetes, diabetic neuropathy, hypertension, hypoglycemia, mild cognitive impairment (MCI), and peripheral artery disease (PAD).