D'Arcy Gue

ICD-9 and ICD-10 Mapping Discrepancies Will Impact Processes

October 8, 2013

ICD-10 2 Minute Read

We’re less than a year away from the deadline for converting to ICD-10. There is a lot of work to do in the next year and mitigating the risks of the transition is necessary. It is unlikely that providers will be able to avoid disruptions to their financial, clinical, and administrative functions, but the more preparation, the less disruption.time to plan

An important step in transition preparations is the mapping between code versions. Since ICD-10 codes are not matched exactly with ICD-9, approximations and mismatches will occur.

The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) created General Equivalence Mappings (GEMs) to assist with the conversion. GEMs, also known as crosswalks, assists with dual coding processes and ensures that consistency in national data is maintained.

GEMs is a powerful tool and forms the basis for an industry standard crosswalk and mapping tool. However, because matches between ICD-9 and ICD-10 are imprecise, organizations must customize the crosswalk to reflect its particular business, clinical, and financial needs.

Implement a dual coding strategy to eliminate problems in critical areas, such as:

  • Care services prior to October 1, 2014 will require continuing use of ICD-9 code sets for some time. (e.g., resubmissions, appeals, etc.) Need for reporting in either ICD-9 or ICD-10
  • Need to validate both ICD-9 and ICD-10 code, simultaneously
  • Enabling continued historical and longitudinal comparisons

The scope of dual coding should be based on specific priorities and practicality for your organization. It is necessary to develop processes to ensure that proper translations occur, and that transactions go to the correct system. To make this successful, we suggest maintaining an audit trail of translations made and the systems involved in those translations.

It is also necessary to ensure that original transactions and service history can be reconstructed in their original codes for any business process that relies on the submitted code.

As with any significant organizational change, it’s vital that all parties be involved and understand the new processes and crosswalk strategy. Establish a communications strategy that achieves this.

It is important to note that GEMs is not a substitute for learning to use ICD-10. It’s simply a solution for bridging the gap between the 9th and 10th edition. Once the deadline arrives, coders will be required to use ICD-10-CM and ICD-10-PCS codes.

For additional details regarding GEMs, visit CMS.gov.

If you are seeking guidance for the move to ICD-10, don’t hesitate to contact one of our experts. We’re happy to answer questions and provide assistance in your transition.

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