Report: New Medical Coding System Not Yet An Improvement in California Comp

A new report shows that an updated medical coding system that went into effect in California a year-and-a-half ago hasn’t done much to better define the characteristics of worker injuries than the old one.

A report by the California Workers’ Compensation Institute on the use of ICD-10 codes in California workers’ comp during the transition from the ICD-9 system shows a wider range of codes were provided than in the past, but that many lacked the additional characters that better define the injury, identify the type of encounter and improve communication.

The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) became the standard classification system on Oct. 1, 2015, for all healthcare delivery systems in the U.S., including workers’ comp.

The adoption of the new system was the first time in 21 years that the codes used by medical providers to describe a patient’s clinical status had been updated.

The transition from the outdated ICD-9 coding system was intended to allow more accurate and precise descriptions of a patient’s clinical status to facilitate communication between medical providers, providers and payers and government agencies. The new code sets also enable statistically relevant groupings that are intended to improve the data used to track public health conditions, conduct epidemiological research on illnesses and co-morbidities and assess the types and outcomes of care provided to patients.

The California Division of Workers’ Compensation allowed medical providers a one-year transition period during which they could use ICD-10 codes that did not strictly meet the level of coding specificity called for by the new classification format and structure, but as of Oct. 1, 2016, workers’ comp medical services that are not coded at the required specificity level are out of compliance.

The CWCI report, the first in a two-part series, examines the components of injury classification and compares ICD-9 diagnostic codes submitted by California workers’ comp medical providers in the final nine months under the old coding system to the ICD-10 codes submitted in the first nine months of the transition period.

Findings from the report include:

• The top 10 ICD-10 diagnoses accounted for 20 percent of the primary diagnoses submitted in the first nine months of the transition.
• Diagnosis codes related to lumbar spine injuries accounted for six of the top 10 ICD-10 codes for services rendered in the first nine months of the transition. Despite high levels of specificity allowed by the ICD-10s, lumbar spine codes ranged from very low specificity – “low back pain” was the number one code submitted – to more specific diagnoses, such as radiculopathy, disc displacement and disc degeneration.
• More than one-in-five ICD-10 codes submitted for shoulder pain diagnoses failed to include a sixth character to identify which shoulder was injured.
• A diagnosis of “injury, unspecified” continued to account for 1.6 percent of primary diagnosis codes under ICD-10, as was the case under ICD-9 submissions.

CWCI has published its report, Injury Classification in California Workers’ Comp, Part 1: Medical Coding During the ICD-10 Transition, which is available on the group’s website.

Part 2 of the series is expected compare the two diagnosis and injury classification systems now used in California workers’ comp: the ICD-10 codes submitted by medical providers and the body part, nature of injury, and cause of injury data noted by claims administrators.

Topics California Workers' Compensation Medical Professional Liability