Evaluation of DoD Syndrome Mapping and Baseline for ICD-9-CM to ICD-10-CM Transition

Jessica Deerin, Jean-Paul Chretien, Paul Lewis

Abstract


ObjectiveThe transition from ICD-9-CM to ICD-10-CM requires evaluationof syndrome mappings to obtain a baseline for syndromic surveillancepurposes. Two syndrome mappings are evaluated in this report.IntroductionThe Department of Defense conducts syndromic surveillanceof health encounter visits of Military Health System (MHS)beneficiaries. Providers within the MHS assign up to 10 diagnosiscodes to each health encounter visit. The diagnosis codes are groupedinto syndrome and sub-syndrome categories. On October 1, 2015,the Health and Human Services-mandated transition from ICD-9-CM to ICD-10-CM required evaluation of the syndrome mappingsto establish a baseline of syndrome rates within the DoD. The DoDdata within the BioSense system currently utilizes DoD ESSENCEsyndrome mappings. The Master Mapping Reference Table (MMRT)was developed by the CDC to translate diagnostic codes across theICD-9-CM and ICD-10-CM encoding systems to prepare for thetransition. The DoD ESSENCE and MMRT syndrome definitions arepresented in this analysis for comparison.MethodsDoD data was pulled from the BioSense Platform through aRStudio server on October 11, 2016, querying data from October1, 2014 to September 30, 2016. This time period provides twelvemonths of ICD-9-CM data and twelve months of ICD-10-CM data.The ICD codes were binned to both DoD ESSENCE syndromes andMMRT macro syndromes for comparison. Although a patient visitmay contain up to 10 ICD codes, only the first four were includedfor this analysis. Providers are trained to prioritize diagnosis codesby position. Only 2.2% of visits had greater than 4 diagnostic codes.Each ICD code in a visit is binned to an applicable syndrome. Thetotal number of visits includes visits that binned and did not bin toa syndrome. Multiple syndromes may be assigned to one patient’shealth encounter visit if multiple ICD codes are binned. Additionally,more than one code per visit may bin to the same syndrome; however,only unique syndromes are counted in the total syndrome rate. Thetotal syndrome rate was calculated by total unique syndrome visitsas the numerator and total number of visits during the ICD-9-CM orICD-10-CM time period as the denominator. The rates per 1000 totalvisits were calculated.ResultsAmong the DoD ESSENCE syndromes, the ICD-9-CM ratefor ILI was 36.3 per 1,000 compared to the ICD-10-CM rate of38.6 per 1,000. The ICD-9-CM rate for neurological was 18.1 per1,000 compared to the ICD-10-CM rate of 0.2 per 1,000.Among the MMRT syndromes, the ICD-9-CM rate for ILI was16.7 per 1,000 compared to the ICD-10-CM rate of 38.4 per 1,000.The ICD-9-CM rate for mental disorders was 73.8 per 1,000 comparedto the ICD-10-CM rate of 73.2 per 1,000.ConclusionsThis analysis provides baseline rates of MMRT syndromes andsub-syndromes for syndromic surveillance during the ICD-9-CM toICD-10-CM transition. These data will serve for future comparisonand tracking of syndrome-specific trends for military-relevant healththreats.

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DOI: https://doi.org/10.5210/ojphi.v9i1.7594



Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org