11 Sep Patient Safety Indicators Likely To Change Under New ICD-10 Coding
Medical Research: What are the main findings of the study?
Dr. Lussier: The main finding is that reporting patient safety using ICD-10-CM coding schema rather than ICD-9-CM will change the reported percentage of adverse events reported for half the specific “patient safety indicators” (PSIs), even with a true unaltered frequency of reported events in the medical center. For some patient safety indicators, the reported frequency will appear to increase substantially and for others, it will appear to decrease. The latter is particularly worrisome as it may erroneously appease administrators and prospective clients (patients) as their apparent trend is improving, while their institution may inadvertently be under-reporting adverse events.
Medical Research: Were any of the findings unexpected?
Dr. Lussier: Patient safety indicators reported in a different coding schema were expected to change, what was unexpected is the level of change that we predict. For example, PSI-5 and PSI-21 “complications of foreign body during the procedure” are likely to be under-reported due to the many alternate ways ICD-10-CM allows to correctly code this complication, while the calculation of the patient safety indicators does not capture all the alternative coding. The redefinitions of PSI-5 and PSI-21 using ICD-10-CM rather than ICD-9-CM codes are likely to cause confusion without a meticulous level of detail to coding in multiple settings.
Medical Research: What should clinicians and patients take away from your report?
Dr. Lussier: Comparing frequencies of adverse events trends must be conducted within periods reported in one schema: the period of ICD-10-CM or that of ICD-9-CM. Across coding schemes , the trends of reported adverse events will not match and would required careful interpretations . We provide the likely biases of over or under reporting for each Patient Safety Indicator when comparing across ICD-10-CM and ICD-9-CM.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Lussier: Ethical organizations addressing ‘data-, process-, and system-focused’ improvements could be penalized using the new ICD-10-CM Agency for Healthcare Research and Quality PSIs because of apparent increases in patient safety indicators bearing the same PSI identifier and label, yet calculated differently.
However. the complexity and alternative of ICD-10-CM may also provide loopholes for organizations to “legally underreport” inadvertently or unethically as a planned strategy. Additional studiers should seek to identify these loopholes and inform Agency for Healthcare Research and Quality for defining coding styles across alternatives or including alternative in the definitions of each AHRQ’s patient safety indications.
Challenges and remediation for Patient Safety Indicators in the transition to ICD-10-CM
Andrew D Boyd, Young Min Yang, Jianrong Li, Colleen Kenost, Mike D Burton, Bryan Becker, Yves A Lussier
J Am Med Inform Assoc amiajnl-2013-002491Published Online First: 3 September 2014 doi:10.1136/amiajnl-2013-002491