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ICD-10


ICD-10 S


By John Wollman


avvy healthcare organizations are already starting to remediate for ICD-10, well ahead of the mandated Oct. 1, 2013 deadline for implementation of the new coding system. In the meantime, they also have to meet the Jan. 1, 2012 deadline for HIPAA 5010, as well as new requirements introduced by the Patient Protection and Affordable Care Act and meaningful-use requirements estab- lished by the HITECH Act. That’s a huge amount of business process adaptation and IT work to be handled in a short period of time. Many payers and providers don’t have the resources or the time to get it all done.


John Wollman is executive VP, healthcare, HighPoint Solutions. For more information on HighPoint solutions: www.rsleads.com/107ht-204


For ICD-10 in particular, adopting a master data manage- ment (MDM) approach can resolve several challenges with implementation of this new code set by establishing a single, centralized, controlled point of


reference for disease/procedure codes, rules, mappings and translations that can be applied uniformly to all applications and processes.


ICD-10 complexities inhibit adoption ICD-10 vastly increases the number and complexity of disease and procedure codes over ICD-9, the previous standard enacted in 1977. ICD-10 contains 141,060 codes, a whopping 712 percent increase over the 19,817 codes in ICD-9. Given the dramatic increase in codes from ICD-9 to ICD-10, one might expect that there would be a one-to-many relationship between ICD-9 and ICD-10, which would make it fairly straightforward to link across the code sets. However, the relationship is many to many, as illustrated within diabetes mellitus.


As expected, one ICD-9 code can relate to many


ICD-10 codes (see Figure 1). But, unexpectedly, one ICD-10 code can also relate to many ICD-9 codes (see Figure 2).


16 July 2011 Figure 1 Figure 2


To help facilitate care and commerce, the government has invested in providing mappings between ICD-9 and ICD-10 and vice-versa. There are two such mappings endorsed by CMS: the GEMS maps (for both ICD-9 to ICD-10 and ICD- 10 to ICD-9) and the reimbursement maps (for ICD-10 to ICD-9 only). GEMS, which stands for “general equivalency maps,” establishes links among codes that are generally equiva- lent in each code set. The reimbursement maps were created after the GEMS maps and are more specifi c, identifying the top candidate mappings from within GEMS. Some statistics may illuminate the challenges inherent in linking across the code sets.


In the GEMS maps for procedures from ICD-9 to ICD-10:


• There are 255 instances where a single ICD-9 code can map to more than 50 ICD-10 codes.


• There are 119 instances where a single ICD-9 code can map to more than 100 ICD-10 codes.


Continued on page 20 HEALTH MANAGEMENT TECHNOLOGY www.healthmgttech.com


A MASTER DATA CHALLENGE ICD -10 is mandated at a diffi cult time of many changes.


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