June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
The Impact of Conversion to International Classification of Diseases, 10th revision (ICD-10) on an Academic Ophthalmology Practice after 1 year
Author Affiliations & Notes
  • Justin Hellman
    Department of Ophthalmology & Vision Sciences, UC Davis Medical Center, Sacramento, California, United States
  • Michelle Lim
    Department of Ophthalmology & Vision Sciences, UC Davis Medical Center, Sacramento, California, United States
  • Cameron Blount
    Department of Ophthalmology & Vision Sciences, UC Davis Medical Center, Sacramento, California, United States
  • Glenn Yiu
    Department of Ophthalmology & Vision Sciences, UC Davis Medical Center, Sacramento, California, United States
  • Footnotes
    Commercial Relationships   Justin Hellman, Allergan (I), Ophthotech (I); Michelle Lim, None; Cameron Blount, None; Glenn Yiu, Alcon (F), Allergan (C), Carl Zeiss Meditec (C)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5081. doi:
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      Justin Hellman, Michelle Lim, Cameron Blount, Glenn Yiu; The Impact of Conversion to International Classification of Diseases, 10th revision (ICD-10) on an Academic Ophthalmology Practice after 1 year. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5081.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The conversion from ICD-9 to ICD-10 was the biggest change to ophthalmic coding in the last 30 years. We performed a retrospective, observational study to examine the clinical and financial impact of conversion from ICD-9 to ICD-10 coding.

Methods : 78,133 billable patient encounters were analyzed in the 1 year period before (10/1/14-9/30/15) and after (10/1/15-9/30/16) conversion from ICD-9 to ICD-10 at the UC Davis Eye Center. Relative value units (RVU) per visit, revenue per visit, volume of patient visits, patient visit coding levels, coder efficiency, and number of claim denials due to improper coding were compared. The top 15 most commonly used ICD-9 codes without a direct correlate in ICD-10 were identified and compared with their 409 possible corresponding ICD-10 codes to see how often unspecified ICD-10 codes were used. The top 50 most commonly used ICD-10 codes used from 10/1/15 to 10/1/16 were analyzed similarly. Two-tailed Student’s t-tests were used for statistical analysis.

Results : There was no significant difference in revenue per visit in the period before the change to ICD-10 ($277.66 ± $5.81) and the period after ($300.65 ± $45.17) (P = 0.16). There were no significant differences in RVUs per visit (P = 0.831), patient visits (P = 0.981), or percentage of higher-level visit codes (P = 0.582) between the two periods. The number of denied claims due to errors in coding per 100 visits increased from 1.02 ± 0.84 to 2.14 ± 0.57 (P = 0.008). The mean monthly percentage of transactions coded within 0-3 days of the encounter did not change significantly (P = 0.437). Among the ICD-10 codes analyzed, 21.5-33.1% were unspecified. The majority of the unspecified codes were glaucoma (45.1%) and refractive (38.4%) diagnoses. There was no change in the total number of codes used per month (p = 0.667).

Conclusions : While the first year of ICD-10 use in America is reported to be a “grace period” where claims in the correct family of codes are not denied, we found a significant increase in denials due to coding errors and found that we are still using a large percentage of unspecified codes, particularly with glaucoma and refractive diagnoses. However, neither clinical volume nor revenue was affected. With the end of the grace period 10/1/16, we anticipate a further increase in denied claims with a possible decrease in revenue.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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