The International Statistical Classification of Diseases and Related Health Problems (ICD) is implementing ICD-10 in the very near future. ICD-10 is the international standard's 10th revision for disease codes and classifications. As surgeons and medical professionals begin preparing for the transition from ICD-9 to ICD-10, two steps are absolutely critical to implement.
First, mapping is a tool that will help medical professionals compare the differences in codes and necessary documents between ICD-9 and ICD-10. Ultimately, mapping involves using ICD-9 as a comparative reference tool until physicians and medical professionals become confident with the new codes and requirements of ICD-10.
Second, crosswalks are tools that will help medical teams convert data from ICD-9 to ICD-10. Crosswalks are often called General Equivalence Mappings (GEMs), and they help serve as a comprehensive translation dictionary that aids in the transition from ICD-9 to ICD-10. Using mapping and crosswalks in tandem will help medical teams successfully prepare for the upcoming ICD-10 transition.
Mapping Is an Essential Element of Proper ICD-10 Planning
As mentioned, mapping will compare the codes of ICD-9 with the codes of ICD-10 that are used to treat the same conditions. The mapping process will provide a few benefits that are crucial for a medical team's success. First, surgeons and physicians will easilyidentify the differences in documentation requirements. Once these differences are identified, physicians will be able to discern whether their teams are meeting the increased requirements of ICD-10. If the teams are not meeting the highest document specificity requirements, the mapping process gives a team time to correct the problems by using the more detailed code descriptions while making improvements to other key processes.
In short, mapping offers a quick snapshot of where the team is operating inefficiently with regards to the new changes, which quickly allows medical professionals to hone in on the specific areas to improve upon. Beyond this crucial element, mapping can also be used as a tool for the upcoming code transition. ICD-9 can be used as a reference point for coding in ICD-10 since the upcoming ICD-10 code uses a novel structure that medical teams have not built a familiarity with.
The ICD-10 code structure employs between three to seven characters, and the character patterns are varied. While quite different form ICD-9, the old codes can still be used as a helpful reference point until coding becomes second-nature while using only ICD-10's framework.
To map effectively, teams should target their most used ICD-9 codes from their billing system and then identify the ICD-10 equivalents. In some instances, ICD-10 can have more than 2,000 additional codes for the same injury or condition, and medical practices must fully implement these code descriptions of ICD-10 before October 1, 2015. Due to the increased complexity of ICD-10, crosswalks are a must-have resource for converting data into an ICD-10 appropriate framework by the start of October.
Utilizing GEMS for Crosswalk Success
GEMs are an essential crosswalk success tool that translate a wide range of ICD-9 data into ICD-10 data, including:
- Tracking Quality
- Reimbursement Calculations
- Converting ICD-9 Applications into ICD-10 Applications
- Recording Morbidity/Mortality
- And More
GEMs also work in tandem with the mapping processes. Mapping from ICD-10 back to ICD-9 (backwards mapping) is possible, and so is mapping from ICD-9 to ICD-10 (forward mapping). GEMs are ultimately complete dictionaries of the mapping possibilities, and GEMs can then take these codes and translate them as necessary.
Of course, GEMs should not be viewed as a replacement for medical professionals learning ICD-10 on their own. Where individual claims are concerned, it is always more effective to work from the record documentation and use the codes provided in the ICD-10 coding books. Additionally, GEMs do not provide all possible translations from ICD-9 to ICD-10.
However, the GEMs remain an essential tool for converting the large databases of ICD-9 data into ICD-10 since it greatly simplifies the transition process and allows medical professionals to effectively familiarize themselves with the new system. Given the increased specificity of ICD-10, utilizing mapping and GEMs will serve as the necessary bridge for moving from ICD-9 to ICD-10 in an effective, successful manner.