ICD-10 Maps May Prevent Coders From Being Lost in Translation
For those well versed in ICD-9, learning ICD-10 may be akin to learning a second language. Many coders say their biggest fear about the new system that will take effect October 1, 2013 is that it requires a different coding logic (particularly ICD-10-PCS), but that it's also so much more specific than ICD-9.
It's no wonder why coders feel this way. In ICD-9, there are 14,025 codes from which to choose. In ICD-10, this number is nearly five times that amount (68,069). Coders' fear of greater specificity is even more warranted given the oftentimes sparse or unspecified physician documentation from which they must assign diagnosis codes.
The good news is that CMS is working toward creating a general equivalence map (GEM) between the two systems that will help coders and others understand how codes in ICD-9 will translate to ICD-10.
The GEMs will serve as a reference for how one ICD-9 code may map to a series of ICD-10 codes or vice versa, says Shannon McCall, RHIA, CCS, CCS-P, CPC, director of coding and HIM for HCPro, Inc., in Chesterfield, VA. "The GEM is only a map—not a crosswalk," she says. "There will not necessarily be a one-to-one translation from ICD-9 to ICD-10," she adds.
However, the GEMs are important in terms of data quality and preservation, she says. "It's not just about implementing a revised classification system and forgetting about the previous version. Many projects like auditing and retrospective reviews will still require flexibility in referencing the correct coding classification system used for the dates of services," she says. "We also don't want to lose 30 years worth of data by moving to a new system in which we scrap everything else."
The process of mapping ICD-9 to ICD-10 will surely prove to be no small task, but it is a necessary step in ensuring a smooth transition between the two coding systems. CMS reiterates the importance of moving to ICD-10 and outlines its plans to map the new system with ICD-9 in several recently released publications, including a General Equivalence Mapping: Top 10 Question and Answer Fact Sheet as well as an ICD-10 User Guide.
In its Fact Sheet, CMS says the intended audiences for the GEMs are coding professionals, payers, providers, medical researchers, informatics professionals, and any other individuals who use coded data. These individuals can use the GEMs to convert payment systems, payment and coverage edits, risk adjustment logic, quality measures, and a variety of research applications that involve trend data.
CMS will also hold a national provider conference call about the GEMs on May 19 from 1 p.m. to 2:30 p.m. EST. CMS has provided downloadable presentation materials. The conference call will discuss the following:
- An overview of the ICD-10 final rule, which requires the implementation of
- ICD-10-CM/PCS on October 1, 2013
- The differences between ICD-9-CM and ICD-10-CM/PCS codes
- The use of the General Equivalence Mappings that have been created to assist in converting policies, edits, and trend data from ICD-9-CM to ICD-10-CM/PCS
- The resources that are available to assist in planning for the transition from ICD-9-CM to ICD-10-CM/PCS
The ICD-9-CM Coordination and Maintenance Committee will discuss updating the GEMs for a minimum of three years after ICD-10 is implemented on October 1, 2013.
Lisa Eramo, CPC is a senior managing editor in the health information management division of HCPro, Inc. She is located in Rhode Island and writes content for the company's flagship newsletter, Medical Records Briefing.
- Healthcare Leaders Seek Strategic Sweet Spot
- 3 Reasons Wellness Programs Fail
- CMS Issues Health Insurance Exchange Proposed Rules
- Patients Shoulder Nearly 25% of Medical Bills
- ACOs Widespread, Yet Challenged
- MGMA: Physician Compensation Increasingly Based on Quality Measures
- Healthcare Costs 'An Abomination' Says Senate Finance Committee Chair
- Healthcare Consolidation: M&A Not the Only Way
- 6 CNO-to-CEO Strategies
- PwC: Pace of Rising Medical Costs Slowing