Determination of problematic ICD-9-CM subcategories for further study of coding performance: Delphi method

Area of Science:

• Medical coding and health informatics
• Qualitative research methodologies

Background:

• Accurate International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding is crucial for healthcare reimbursement and data analysis.
• Identifying problematic subcategories within ICD-9-CM is essential for improving coding accuracy and reducing variation.

Purpose of the Study:

• To employ the Delphi method to identify specific ICD-9-CM subcategories that present the greatest challenges for coders.
• To establish a framework for selecting subcategories for further investigation based on objective criteria.

Main Methods:

• A panel of independent coding experts utilized the Delphi method, a qualitative approach.
• Criteria for identifying problematic subcategories were established as cost, volume, and level of coding confusion.
• The Medicare Provider Analysis and Review (MEDPAR) dataset from fiscal year 2007 was analyzed alongside expert suggestions.
• Two rounds of independent expert ranking were conducted to determine the most problematic subcategory.

Main Results:

• The Delphi method successfully identified key criteria (cost, volume, confusion) for problematic ICD-9-CM subcategories.
• Excisional Debridement was identified as the subcategory causing the most significant coding confusion among experts.
• The study provides a validated schema for prioritizing code sets for improvement initiatives.

Conclusions:

• The Delphi method is an effective tool for identifying areas of coding difficulty within complex code sets like ICD-9-CM.
• Excisional Debridement warrants further research to enhance coding accuracy and consistency.
• The proposed framework can be adapted to identify and address coding challenges in other medical code sets.