Feasibility of replacing the ICD-10-CM with the ICD-11 for morbidity coding: A content analysis

ObjectiveThe study sought to assess the feasibility of replacing the International Classification of Diseases–Tenth Revision–Clinical Modification (ICD-10-CM) with the International Classification of Diseases–11th Revision (ICD-11) for morbidity coding based on content analysis.Materials and MethodsThe most frequently used ICD-10-CM codes from each chapter covering 60% of patients were identified from Medicare claims and hospital data. Each ICD-10-CM code was recoded in the ICD-11, using postcoordination (combination of codes) if necessary. Recoding was performed by 2 terminologists independently. Failure analysis was done for cases where full representation was not achieved even with postcoordination. After recoding, the coding guidance (inclusions, exclusions, and index) of the ICD-10-CM and ICD-11 codes were reviewed for conflict.ResultsOverall, 23.5% of 943 codes could be fully represented by the ICD-11 without postcoordination. Postcoordination is the potential game changer. It supports the full representation of 8.6% of 943 codes. Moreover, with the addition of only 9 extension codes, postcoordination supports the full representation of 35.2% of 943 codes. Coding guidance review identified potential conflicts in 10% of codes, but mostly not affecting recoding. The majority of the conflicts resulted from differences in granularity and default coding assumptions between the ICD-11 and ICD-10-CM.ConclusionsWith some minor enhancements to postcoordination, the ICD-11 can fully represent almost 60% of the most frequently used ICD-10-CM codes. Even without postcoordination, 23.5% full representation is comparable to the 24.3% of ICD-9-CM codes with exact match in the ICD-10-CM, so migrating from the ICD-10-CM to the ICD-11 is not necessarily more disruptive than from the International Classification of Diseases–Ninth Revision–Clinical Modification to the ICD-10-CM. Therefore, the ICD-11 (without a CM) should be considered as a candidate to replace the ICD-10-CM for morbidity coding.     

关于人工关节置换手术的ICD-9-CM-3编码

目的总结人工关节置换手术的分类原则;方法结合编码工作的实践,将这类问题进行分析、归纳。结果上肢关节置换术分类在81这一类目的不同亚目,其修复术分类于81.97;下肢关节置换与修复术根据不同部位及修复的特指成分,分类在不同类目与细目。结论人工关节置换的手术分类要首先明确关节置换的部位和类型、其次应明确是首次置换还是关节翻修,然后再查找相应编码。     

骨固定术的ICD-9-CM-3分类辨析

目的探讨骨固定术准确的ICD-9-CM-3编码。方法通过学习骨固定术的相关文献,仔细阅读病案,按照分类原则进行ICD-9-CM-3编码。结果不伴有骨折复位的骨内固定术的编码为78.5、外固定术的编码为93.4和93.5;伴有骨折复位的骨固定术的编码为79.1和79.3中;使用骨外固定装置的编码为78.1和84.7。结论编码员不但要掌握ICD编码知识,还要学习相关的医学基础知识和仔细阅读病案,才能做到准确编码。     

关于结肠息肉的 ICD-9-CM-3 手术分类

临床上根据结肠息肉的部位、性质、大小、多少以及有无癌变的倾向,通常采取4类手术方式,分别是结肠息肉内镜下摘除术、经腹结肠息肉切除术、结肠部分切除术和结肠全部切除术,其手术编码均有所不同。编码员要熟练掌握相关的编码原则和方法,翻阅病案,结合病理,才能做到编码的准确。     

斜视矫正术的ICD-9-CM-3编码探讨

通过对斜视矫正术的分析,依据国际疾病分类第九版临床修订本手术与操作ICD-9-CM-3（2008版）对斜视矫正术的手术操作进行编码,一条眼外肌的后徙术编码为15.11;一条眼外肌的延长术编码为15.21;两条或者两条以上眼外肌的其他手术编码为15.4.在编码过程中编码员应熟练掌握手术操作编码的原则,仔细阅读手术记录,充分与临床医师沟通,才能确保编码准确.     

微创腰椎融合术的ICD-9-CM-3编码探讨

微创腰椎融合术术式繁多,椎管减压和腰椎融合容易出现编码错误。原因有医师书写手术名称不规范和编码人员对手术知识不了解。因此在对此类手术进行编码时,要多查阅脊柱融合的相关手术知识;多与临床医师沟通,规范手术名称的书写,进一步了解手术实施的步骤和最新的进展;详细查阅手术记录,确定微创术式、椎管减压的类型及融合椎骨的数目,并结合手术材料清单,判断是否应用了椎间融合器或植入椎间物质,这样才能做出准确编码,为临床医、教、研提供最具价值的病案信息。     

ICD-9-CM-3中未特指编码误用问题探讨

目的 了解ICD-9-CM-3中具有未特指情况的手术与操作编码误用问题,分析错误原因,探讨对策.方法 总结201 1版ICD-9-CM-3中所有具有未特指情况的手术与操作编码,与北京协和医院现有手术和操作编码字典库进行比对,并在北京协和医院病案首页管理信息系统下对2012年住院首页信息中手术与操作的上述编码逐一进行检索,统计误用编码检索量,计算误用率.结果 参照最新版ICD-9-CM-3,共筛选出162个具有未特指情况的手术与操作编码,其中58个编码存在于我院字典库,逐一进行检索后发现的60.3％（35/58）的编码有病例支持,存在误用现象.总体上具有未特指情况编码误用率为15.5％,“NOS”编码误用率和“unspecified”编码误用率分别为17.0％和5.6％.结论 病案编目人员应谨慎使用具有未特指情况的手术与操作编码,建议添加编码信息质控程序提高编码准确性.     

肿瘤经血管介入治疗ICD-9-CM-3编码分析

探讨肿瘤经血管介入治疗的术式和常见的肿瘤种类,总结归纳每种术式和肿瘤种类的相应编码。肿瘤经血管介入治疗术式包括经导管血管内灌注化疗、经导管血管栓塞术和经导管血管内栓塞化疗。经血管介入治疗的肿瘤类型包括肝肿瘤、肺肿瘤、子宫肿瘤和食管肿瘤等。肿瘤经血管介入治疗ICD-9-CM-3编码,有3个步骤,首先确定治疗的术式,其次确定治疗的血管,然后编码血管造影术。经导管血管内灌注化疗需要编码化疗(99.25),灌注的部位,造影的血管;经导管血管栓塞术需要编码血管栓塞,血管栓塞既要区别栓塞的血管,有时也需要区别栓塞物质,还要编码血管造影;经导管血管内栓塞化疗需要编码血管栓塞、化疗(99.25),灌注的部位,血管造影。     

影响介入操作ICD-9-CM-3编码的相关情况研究

目的通过对影响介入手术操作编码的相关情况进行讨论分析,以利于作出准确的编码。方法根据ICD-9-CM-3的分类原则,将分析资料按其治疗的目的、治疗的部位、操作的人路以及疾病性质进行分组。结果介入操作的手术编码因治疗的目的、治疗的部位以及疾病性质不同应给予不同的手术（操作）编码。结论全面了解介入操作的目的、部位、方法以及操作过程是正确编码的关键。     

选择性阴茎背神经离断术手术编码的探讨

目的 探讨选择性阴茎背神经离断术手术编码.方法 采用ICD-10以F52.4（早泄）为检索词,在病案统计管理系统检索出2009-2013年病例277份,其中操作210例手术,以ICD-9-CM-3 2008版为工具书,回顾性分析选择性阴茎背神经离断术手术编码的质量.结果 发现错误编码64.2阴茎病损的局部切除术或破坏术124例,误编64.4阴茎修补术和整形术51例;03.1脊髓内神经根切断或脊神经根切断术35例,错误率16.66％,正确编码应为04.03其他颅的和周围神经切断术或压轧术,延拓细化尾码04.0301.结论 编码员对手术范围,术式以及解剖部位的错误判断导致选择性阴茎背神经离断术编码错误.手术确定阴茎背神经的解剖位置是编码的关键,编码员必须认真阅读手术记录,熟练掌握解剖知识,提高医学知识和国际疾病分类专业技能,才能确保编码准确.     

Prolift盆底重建术的ICD-9-CM-3编码

目的掌握prolift盆底重建术的编码。方法介绍prolift盆底重建术的相关知识,用ICD-9-CM-3查找prolift盆底重建术编码。结果前盆底重建术70．54,后盆底重建术70．55,全盆底重建术70．53。结论编码员不但掌握ICD-9-CM．3的查找方法,还要不断学习积累相关的医学知识,仔细阅读病案,才能准确编码。     

Research and applications: The discriminatory cost of ICD-10-CM transition between clinical specialties: metrics,case study,and mitigating tools

Objective

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.     

Metrics and tools for consistent cohort discovery and financial analyses post-transition to ICD-10-CM

In the United States, International Classification of Disease Clinical Modification (ICD-9-CM, the ninth revision) diagnosis codes are commonly used to identify patient cohorts and to conduct financial analyses related to disease. In October 2015, the healthcare system of the United States will transition to ICD-10-CM (the tenth revision) diagnosis codes. One challenge posed to clinical researchers and other analysts is conducting diagnosis-related queries across datasets containing both coding schemes. Further, healthcare administrators will manage growth, trends, and strategic planning with these dually-coded datasets. The majority of the ICD-9-CM to ICD-10-CM translations are complex and nonreciprocal, creating convoluted representations and meanings. Similarly, mapping back from ICD-10-CM to ICD-9-CM is equally complex, yet different from mapping forward, as relationships are likewise nonreciprocal. Indeed, 10 of the 21 top clinical categories are complex as 78% of their diagnosis codes are labeled as “convoluted” by our analyses. Analysis and research related to external causes of morbidity, injury, and poisoning will face the greatest challenges due to 41 745 (90%) convolutions and a decrease in the number of codes. We created a web portal tool and translation tables to list all ICD-9-CM diagnosis codes related to the specific input of ICD-10-CM diagnosis codes and their level of complexity: “identity” (reciprocal), “class-to-subclass,” “subclass-to-class,” “convoluted,” or “no mapping.” These tools provide guidance on ambiguous and complex translations to reveal where reports or analyses may be challenging to impossible.Web portal: http://www.lussierlab.org/transition-to-ICD9CM/Tables annotated with levels of translation complexity: http://www.lussierlab.org/publications/ICD10to9     

Mapping clinical phenotype data elements to standardized metadata repositories and controlled terminologies: the eMERGE Network experience

Background

Systematic study of clinical phenotypes is important for a better understanding of the genetic basis of human diseases and more effective gene-based disease management. A key aspect in facilitating such studies requires standardized representation of the phenotype data using common data elements (CDEs) and controlled biomedical vocabularies. In this study, the authors analyzed how a limited subset of phenotypic data is amenable to common definition and standardized collection, as well as how their adoption in large-scale epidemiological and genome-wide studies can significantly facilitate cross-study analysis.

Methods

The authors mapped phenotype data dictionaries from five different eMERGE (Electronic Medical Records and Genomics) Network sites studying multiple diseases such as peripheral arterial disease and type 2 diabetes. For mapping, standardized terminological and metadata repository resources, such as the caDSR (Cancer Data Standards Registry and Repository) and SNOMED CT (Systematized Nomenclature of Medicine), were used. The mapping process comprised both lexical (via searching for relevant pre-coordinated concepts and data elements) and semantic (via post-coordination) techniques. Where feasible, new data elements were curated to enhance the coverage during mapping. A web-based application was also developed to uniformly represent and query the mapped data elements from different eMERGE studies.

Results

Approximately 60% of the target data elements (95 out of 157) could be mapped using simple lexical analysis techniques on pre-coordinated terms and concepts before any additional curation of terminology and metadata resources was initiated by eMERGE investigators. After curation of 54 new caDSR CDEs and nine new NCI thesaurus concepts and using post-coordination, the authors were able to map the remaining 40% of data elements to caDSR and SNOMED CT. A web-based tool was also implemented to assist in semi-automatic mapping of data elements.

Conclusion

This study emphasizes the requirement for standardized representation of clinical research data using existing metadata and terminology resources and provides simple techniques and software for data element mapping using experiences from the eMERGE Network.     

哮喘患者诱导痰白细胞介素-17A与基质金属蛋白酶-9水平测定及其意义

目的测定不同严重程度支气管哮喘患者诱导痰上清液白细胞介素17A（IL-17A）、基质金属蛋白酶-9（MMP-9）、白细胞介素-8（IL-8）的水平,探讨气道慢性炎症的特点及可能机制。方法按标准纳入慢性持续哮喘患者41例：健康对照者15例,采用诱导痰技术对痰炎性细胞进行分类并采用酶联免疫吸附测定（ELISA）法检测痰上清液IL-17A、IL-8、MMP-9水平,并进行相关性分析。结果重度组患者诱导痰中性粒细胞比值[（62．6±15．7）％]与正常对照组[（26．3±10．3）％]、轻度组[（42．3±18．7）％]及中度组[（46．1±14．3）％]比较差异均有统计学意义（P〈0．01或0．05）;重度哮喘患者嗜酸性粒细胞比值[（8．2±3．9）％]与轻度组[（4．9±3．4）％]及对照组[（1．0±0．8）％]比较增高（P〈0．01或0．05）,与中度组[（5．4±3．3）％]比较差异无统计学意义（P〉0．05）;诱导痰上清液IL～17A水平轻度组[（154±91）pg／ml]和对照组[（55±23）pg／ml]与重度组[（262±162）pg／ml]比较差异有统计学意义（P〈0．05）,且各组哮喘患者与正常对照组比较均增高（P〈0．01）;重度组MMP-9水平[（451±251）ng／ml]与轻度、中度组患者[（166±99）ng／ml,（189±110）ng／ml]及对照组[（158±109）ng／ml]比较差异均有统计学意义（P〈0．01）;轻度、中度和重度哮喘患者诱导痰IL-8水平[（387±227）pg／ml,（390±194）pg／ml,（480±217）pg／ml]与健康对照者[（203±104）pg／ml]比较差异有统计学意义（P〈0．01）。诱导痰中性粒细胞比值与IL-17A、IL-8、MMP-9呈正相关（r=0．323,P〈0．05;r=0．493,P〈0．01;r=0．344,P〈0．01）。结论中性粒细胞浸润性气道炎症是重度持续性哮喘的重要特征,IL-17A、IL-8、MMP-9构成的复杂炎症介质网络可能是气道损伤的关键机制之-。