Abstract
Purpose :
ICD-10 implementation increased the use of unspecified codes and coding-related denials in the first year. However, this occurred during the Centers for Medicare and Medicaid Services (CMS) grace period when they would not deny physician claims due to lack of specificity as long as the ICD-10 code from the correct family was employed. The purpose of this study is to determine any further increase in coding-related denials after the CMS grace period.
Methods :
67,447 billable outpatient encounters at the UC Davis Eye Center were analyzed in the 1-year period before implementation of ICD-10 (10/1/14 – 9/30/15), the 1-year grace period after ICD-10 began (10/1/15 – 9/30/16), and the first year after the grace period (10/1/16 – 9/30/17). We analyzed coding-related denials, associated charges, and percentage of unspecified codes. We also compared mean monthly revenue per visit, relative value units (RVUs) per visit, and number of visits, and analyzed each of these factors by department. One-way ANOVA was used to analyze the data with planned contrast analysis of significant results.
Results :
Denials per 100 visits increased from 0.99 ± 0.17 to 1.84 ± 0.09 after conversion to ICD-10 (P=0.013) and increased to 2.74 ± 0.35 following the grace period (P= 0.009). The charges denied due to coding errors per 100 visits increased from $307.73 ± $443.23 to $660.86 ± $239.47 (P=0.04) after ICD-10 implementation, and to $882.25 ± $443.92 (P=0.01) after the grace period. The percentage of unspecified codes used by physicians increased from 26.55% ± 0.48% to 35.00% ± 2.28% after ICD-10 implementation (P < 0.001) and to 38.49% ± 1.35% after the grace period (P < 0.001). There were no significant differences in payment per visit (P = 0.60), RVUs per visit (P = 0.98), or total number of visits (P = 0.98) measured in total or by department with the exception of the cornea department, which showed a decrease in RVUs per visit in the year after the grace period (P=0.02).
Conclusions :
The conversion to ICD-10 resulted in an increase in the rate of unspecified codes used and coding-related denials. These continued to rise in the one year following the CMS grace period, although overall revenue, RVUs, and clinical volume were not affected.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.