Pediatricians could take a financial hit with switch to ICD-10

The switch to ICD-10 could have a substantial impact on pediatricians' bottom lines, according to a study that found that 26 percent of ICD-9 codes used in that specialty are convoluted in their mapping to ICD-10.

The research, conducted at the University of Illinois at Chicago and published in the journal Pediatrics, used Medicaid data to look at 2,708 diagnosis codes used by pediatricians in the University of Illinois Hospital & Health Sciences System. Those codes represented more than $12 million in Medicaid payments, according to an announcement

Using a web-based tool that maps the codes to ICD-10, they categorized them by the complexity of the transition--from easy to complex or convoluted--and studied the financial impact that transition would have.

The convoluted codes represented 16 percent of the total reimbursement. The study also found the potential for information loss, overlapping categories and inconsistent coding represent 8 percent of reimbursement.

Even a loss or payment delay of 5 percent can have a big impact on pediatrics practices, the authors note.

"The potential for financial disruption and administrative errors from 8 percent of reimbursement diagnosis codes necessitates special attention to these codes in preparing for the transition to ICD-10-CM for pediatric practices," they conclude.

The Centers for Medicare & Medicaid Services has just announced that it accepted 89 percent of ICD-10 front-end test claims submitted during a trial run in March with providers, suppliers, billing companies and clearinghouses.

Though the deadline for implementing the new code set has been delayed for a year, pediatricians in particular have been warned to set aside a cash reserve to soften the potential financial impact.

To learn more:
- find the abstract
- here's the announcement