Impact of Icd-10 On Coding of General Surgical Procedures

Hemalkumar Mehta, PhD¹, Courtney Flynn², Anthony J Senagore, MD, MS, MBA¹. ¹University of Texas Medical Branch, ²Medtronic

Background: Beginning October 1, 2015 International Statistical Classification of Diseases and Related Health Problems (ICD)-10 coding was implemented in the US healthcare system for the coding of diagnosis and inpatient procedures. Number of procedure codes increased from 3,882 in ICD-9 to 71,974 in ICD-10. Change to ICD-10 has implications related to change management of coding infrastructure and potentially reimbursement. The goal of the study was to describe how commonly performed surgeries are coded using ICD-10 codes.

Methods: We used Premier hospital inpatient database for Q4, 2015 (first full quarter with ICD-10 coding data). We identified discharges with a primary diagnosis and relevant Medicare Severity-Diagnosis Related Group (MS-DRGs) for appendectomy (338-343), cholecystectomy (411-419), incisional/ventral hernia (350-352), inguinal hernia (353-355), major small and large bowel procedures (329-331), and rectal resection (332-334). Descriptive analysis was conducted to report the top ICD-10 procedure codes.

Results: A total of 5,002 discharges for appendectomy, 10,559 for cholecystectomy, 1,802 for incisional/ventral hernia, 758 for inguinal hernia, 11,453 for major small and large bowel procedures, and 234 for rectal resection were identified. Top primary ICD-10 procedure codes are listed in Table 1. Among top surgical procedures, percutaneous endoscopic approach (minimally invasive, laparoscopic or robotic) accounted for over 89% of appendectomy and cholecystectomy; synthetic mesh was used in ~83% cases and open approach was used in ~76% of cases for incisional/ventral hernia; ~61% cases addressed hernia of right inguinal region versus ~39% for left inguinal region, and mesh was flagged in ~84% cases; open approach accounted for ~58% cases versus ~42% for endoscopic approach, and ~62% cases were for resection or excision of sigmoid colon versus ~38% for right colectomy; open approach accounted for ~66% cases versus ~34% using endoscopic approach for rectal resection.

Conclusion: ICD-10 coding offers granular information on anatomical region of surgery (for inguinal hernia and bowel procedures), approach used (open, endoscopic, robotic) and type of prosthetic used (synthetic, autologous). This opens up new avenues for surgical outcomes research.

Table 1. List of Top ICD-10 Codes by Procedure