The effect of transitioning to ICD-10-CM on acute injury surveillance of active duty service members

Matthew C. Inscore, Katherine R. Gonzales, Christopher P. Rennix, Bruce H. Jones

Acute injuries are a burden on the Military Health System and degrade service members' ability to train and deploy. Long-term injuries contribute to early attrition and increase disability costs. To properly quantify acute injuries and evaluate injury prevention programs, injuries must be accurately coded and documented. This analysis describes how the transition from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to the Tenth Revision (ICD-10-CM) impacted acute injury surveillance among active duty (AD) service members. Twelve months of ICD-9-CM and ICD-10-CM coded ambulatory injury encounter records for Army, Navy, Air Force, and Marine Corps AD service members were analyzed to evaluate the effect of ICD-10-CM implementation on acute injury coding. Acute injuries coded with ICD-9-CM and categorized with the Barell matrix were compared to ICD-10-CM coded injuries classified by the proposed Injury Diagnosis Matrix (IDM). Both matrices categorize injuries by the nature of injury and into three levels of specificity for body region, although column and row headings are not identical. Acute injury distribution between the two matrices was generally similar in the broader body region categories but diverged substantially at the most granular cell level. The proportion of Level 1 Spine and back Body Region diagnoses was higher in the Barell than in the IDM (6.8% and 2.3%, respectively). Unspecified Level 3 Lower extremity injuries were markedly lower in the IDM compared to the Barell (0.1% and 12.1%, respectively). This is the first large scale analysis evaluating the impacts of ICD-10-CM implementation on acute injury surveillance using ambulatory encounter data. Some injury diagnoses appeared to have shifted to a different chapter of the codebook. Also, it's likely that the more detailed diagnostic descriptions and episode of care codes in ICD-10-CM discouraged re-coding of initial acute injury diagnoses. The proposed IDM did not result in a major disruption of acute injury surveillance. However, many acute injury diagnosis codes cannot be aligned between ICD versions. Overall, the increased specificity of ICD-10-CM and use of the IDM may lead to more precise acute injury surveillance and tailored prevention programs, which may result in less chronic injury, reduced morbidity, and lower health-care costs.