Researchers Link ICD-10 Shift to Financial Losses
Venepalli: When you type in a 9 and try to get a 10, what you get from the current GEMs government-provided mapping is a table of numbers. You don't know what to do with those numbers. I had no idea. It is very confusing. Then this tool represents graphically what these conversions are going to look like. It makes it much easier to look at. We would not have been able to do this analysis to quantify how much of our diagnoses are at risk from information loss and at financial loss only using that table of numbers.
Boyd: We gave the tool away for free and the codes we used to design the tool. If someone wants to import it into an (electronic health record) or if someone wants to make a copy of the tool, we are giving everything away for free. It is not even copyrighted. Please use it.
If someone wants to take the code and bring it in-house because they don't want to post their codes on a website, we have given away in a prior paper the Excel file showing the motifs of every ICD-9 code and the database we used to actually derive the concept of convulsion. If someone has added additional mapping to GEMs they can take their own proprietary mappings and use this algorithm to say we are more convoluted or less convoluted than the government.
HLM: Why is the transition proving to be so difficult?
Boyd: Remember, we've got 500 EHR vendors, several hundred insurance companies, and ICD-9 is used for the medical necessity of service. So, most clinicians will just put down an ICD-10 code saying this is the medical diagnosis.
But if the information is wrong and your insurance company uses the incorrect mapping, we don't know what the insurance company is going to do. You may be able to defend the claim. We are just saying here are the hard codes, here is additional information. Make sure your coders are aware of it. Not everyone is going to be able to go through these 150,000 mappings and make sure everyone is clinically correct or even medically necessary.
John Commins is a senior editor with HealthLeaders Media.
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