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Researchers Link ICD-10 Shift to Financial Losses

John Commins, for HealthLeaders Media, March 17, 2014

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.


What's Your ICD-10 HR Strategy?


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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2 comments on "Researchers Link ICD-10 Shift to Financial Losses"


Dan Toren (3/18/2014 at 2:32 PM)
Great questions Susie. From 3M website:"How 3M became the ICD-10 leader Under contract with the Centers for Medicare and Medicaid Services (CMS), 3M designed and developed the ICD-10 Procedure Coding System (ICD-10 PCS) and the General Equivalence Mappings (GEMs). 3M also completed the initial conversion of the CMS MS-DRGs to ICD-10." Disclaimer: we have nothing to do with 3M. However, anticipating the angst of October 1st, we've developed and recently released an app that may help alleviate the anxiety related to the ICD-10 implementation - ICD10Doc. And yes, we have actually used GEM for mapping between ICD-9 and ICD-10. ICDDoc.com is intended especially for the small practices that don't have the support or budgets of a hospital HIM department. You can check it out at http://icd10doc.com Your feedback would be much appreciated Thanks Dan

Susie/Internal Medicine Practice Administrator (3/17/2014 at 10:54 AM)
I am still trying to figure out why there is the switch to ICD-10 in the first place. Real facts, not just government or insurance company public statements. Who wrote/created the GEMs? Is this evidence based medicine? When the author states that the maps may be wrong, most practices simply don't have the time or knowledge to create new algorithms. Is this tool for oncology only? Is this "map" ubiquitously used by Medicare and Commercial insurance companies? In other words, are they sharing the same GEMs? Any assistance would be greatly appreciated. Thank you in advance.