Elucidating challenges and opportunities in the transition to ICD-10-CM.

Throughout the history of medicine, clinicians have worked to classify disease. As early as 1662, John Graunt studied the London Bills of Mortality to report death rates by condition. Originally created for epidemiologic purposes, systems of disease terminology became useful for other purposes, including billing. Since 1979, the International Classification of Diseases, Ninth Revision with Clinical Modifications (ICD-9-CM) has been used for third-party payment in the United States. Worldwide, the 10th revision of the ICD (ICD-10) has been used with local modifications in numerous countries for a decade or more. Now, all US entities covered by the Health Insurance Portability Accountability Act will be required to use ICD-10-CM on or after October 1, 2015. ICD-10-CM has about 5 times as many codes as ICD-9-CM. It is hoped the new codes will be better aligned with current medical terminology, characterize health information that could not be described with ICD-9-CM (eg, Glasgow coma score, blood type), and provide greater detail about health conditions (eg, severity of disease, laterality of anatomic location). The transition to ICD-10-CM should also facilitate comparisons of health outcomes between the United States and other nations. The transition to ICD-10-CM occurs in the context of an accelerating transformation in how electronic health data, including diagnostic codes, are used. Driven by the investment of $19 billion to promote the adoption of electronic health records (EHRs) by the American Recovery and Reinvestment Act of 2009, nearly 80% of office-based physicians are currently using EHRs. These systems may facilitate an increasing number of large-scale research studies and quality improvement (QI) projects in addition to their traditional role in patient care and billing. In the research arena, the Patient-Centered Outcomes Research Institute has funded 11 electronic health record–driven Clinical Data Research Networks, including 1 focused exclusively on pediatrics. Similarly, the American Academy of Pediatrics Pediatric Research in Office Settings Network is working with collaborating networks from across the United States to study through EHR data the safety and efficacy of medication for children. Increasingly positioning pediatricians as active users of EHR data, American Board of Pediatrics Maintenance of Certification Part IV now requires pediatricians to participate in data-driven QI projects. In this setting, pediatricians, their practices and health systems, and researchers and QI experts must recognize the implications of changing from ICD-9-CM to ICD-10-CM. The study by Caskey and colleagues in the current issue of Pediatrics, through a detailed analysis of Illinois Medicaid billing codes, carefully characterizes the many ways that the transition from ICD-9-CM to ICD-10-CM may change the meaning, what clinical informaticians call the semantics, of commonly used codes. The good news is that the authors found that 74% of codes were readily transitioned. However, they found 26% of diagnostic codes, representing 16% of reimbursements, AUTHORS: Alexander G. Fiks, MD, MSCE,abcdef and Robert W. Grundmeier, MDade Pediatric Research Consortium, PolicyLab, Center for Pediatric Clinical Effectiveness, Center for Biomedical Informatics at the Children’s Hospital of Philadelphia, and Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and Pediatric Research in Office Settings at the American Academy of Pediatrics