The switch to ICD-10 poses the risk of under-reporting and over-reporting adverse events due to mismatches in codes for Patient Safety Indicators (PSIs), according to research at the Journal of the American Medical Informatics Association.
The researchers, from the University of Illinois at Chicago, looked at 23 types of PSIs. They found three had straightforward mapping between ICD-9 and ICD-10, while 15 had convoluted mapping and five had no mapping at all.
They pointed at two--PSI-15 and PSI-25 "Accidental puncture or laceration"--that pose significant challenges.
"The completely new organ focus of ICD-10-CM is different from the procedure focus of the ICD-9-CM puncture or laceration, which could lead to under-reporting as there would be an additional need to read the operative report for the specific location of the puncture or laceration," the authors write.
Complications of a foreign body left during a procedure pose similar problems because more than 219 codes cover that.
The report's authors warn that unethical "numbers-focused" translations could be used to trumpet improvements that have not taken place, while patient-safety issues could go underreported. The data on public reporting sites could become useless.
In a recent article in the Journal of the American Health Information Management Association, Sue Bowman, senior director of coding policy and compliance at AHIMA, argues that adoption of the more comprehensive ICD-10 code set will make it easier to find the needed code because fewer codes are left open to interpretation.
The Centers for Medicare & Medicaid Services has stopped publicly reporting on its Hospital Compare website data on certain conditions including hospital-acquired infections and foreign objects left during surgery, arguing the data offer accurate reflection for comparing one hospital against another.
And critics in an New England Journal of Medicine article take issue with CMS's claims that its Partnership for Patients program (PPP) has improved patient care. They criticize the study design, lack of transparency and rigor in evaluation, saying that makes it difficult for healthcare organizations to learn from the improvement efforts.
To learn more:
- check out the research