TABLE 1.
Analyzed Pediatric ICD-9-CM Codes of All Pediatric ICD-9-CM Codes in Illinois Medicaid
| Number of Analyzed Codesa (N = 636) | Codes Analyzed, % | Total Illinois Medicaid Diagnosis Codes, % | Reimbursement (% of Total Reimbursement) | |
|---|---|---|---|---|
| Information loss | 88 | 14 | 2.5 | $455 320.84 (3.6) |
| Overlapping categories | 115 | 18 | 3.2 | $399 302.13 (3.2) |
| Inconsistent | 42 | 7 | 1 | $156 637 (1.2) |
| Consistent | 385 | 61 | 10 | $1 970 000 (15.7) |
| Unanalyzed transition | — | — | 83.3 | $9 300 000 (75) |
The last row represents the percentage of codes and cost that were not analyzed by the pediatricians. Overlapping categories at 3.2% of codes and 3.2% of overall cost is the largest contributor to clinically incorrect concepts.
a
Six codes had no mapping and were excluded from analysis.