Abstract
BackgroundTransitioning from an old medical coding system to a new one can be challenging, especially when the two coding systems are significantly different. The US experienced such a transition in 2015.ObjectiveThis research aims to introduce entropic measures to help users prepare for the migration to a new medical coding system by identifying and focusing preparation initiatives on clinical concepts with more likelihood of adoption challenges.MethodsTwo entropic measures of coding complexity are introduced. The first measure is a function of the variation in the alphabets of new codes. The second measure is based on the possible number of valid representations of an old code.ResultsA demonstration of how to implement the proposed techniques is carried out using the 2015 mappings between ICD-9-CM and ICD-10-CM/PCS. The significance of the resulting entropic measures is discussed in the context of clinical concepts that were likely to pose challenges regarding documentation, coding errors, and longitudinal data comparisons.ConclusionThe proposed entropic techniques are suitable to assess the complexity between any two medical coding systems where mappings or crosswalks exist. The more the entropy, the more likelihood of adoption challenges. Users can utilize the suggested techniques as a guide to prioritize training efforts to improve documentation and increase the chances of accurate coding, code validity, and longitudinal data comparisons.
Highlights
Medical diagnoses and procedures are reported using standardized codes that are updated periodically to keep up with the latest clinical knowledge and practices
In one analysis [11], it was found that the Swiss transition from International Classification of Diseases (ICD)-9 to ICD-10 resulted in the initial increase of the number of coding errors for co-morbidities, but, over time, the accuracy improved as the learning curve waned
The first measure was a function of the variation in the map’s alphabets, and the second measure was based on the possible number of valid combinations of candidate codes in a map
Summary
Medical diagnoses and procedures are reported using standardized codes that are updated periodically to keep up with the latest clinical knowledge and practices. Transitioning from an old medical coding system to a new one can be challenging, especially when the two systems are significantly different. One such transition took place in the United States (US) in 2015 when the country switched from the 9th revision of the International Classification of Diseases (ICD) Clinical Modification (ICD9-CM) to the 10th revision (ICD-10-CM). Each ICD-10-PCS procedure is made of 7 multi-axial characters where each axis encompasses up to 34 alphanumeric values [1] This arrangement is a significant departure from the procedure code structure in ICD-9-CM Vol 3, where all codes are numeric and can only be between 2 and 4 characters long. Transitioning from an old medical coding system to a new one can be challenging, especially when the two coding systems are significantly different.
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