BY BRANDON GRIFFIN Founder, Globonics LLC and Venture Software Development
So you’ve spent thousands (some of you millions) prepping for the ICD-10 transition. You’ve double checked your software vendors, test claims have been submitted, your contracts are all revenue neutral, staff is all trained up, doctors know how to document to the degree of specificity now required, and everything is perfect. Wait you didn’t do all that?
Good news…ICD10 is not that big of deal.
This article only discusses the ICD10 CM diagnosis code set. ICD10 PCS is a whole different animal (F40.218). ICD10 CM consists of 69,823 codes whereas ICD9 was only 14,025. Yikes? Not really, let’s look at where these new codes came from.
The CDC’s summary of where new codes came from http://www.cdc.gov/nchs/icd/ icd10cm_pcs_background.htm
Improved quality of data The granularity of ICD-10-CM and ICD-10- PCS is vastly improved over ICD-9-CM and will enable greater specificity in identifying health conditions. It also provides better data for measuring and tracking health care utilization and the quality of patient care.
The greater level of detail in the new code sets includes laterality, severity, and complexity of disease conditions, which will enable more precise identification and tracking of specific conditions.
Terminology and disease classification are now consistent with new technology and current clinical practice.
Injuries, poisonings and external causes are much more detailed in ICD-10-CM, including the severity of injuries, and how and where injuries happened. Extensions are also used to provide additional information for many injury codes.
Pregnancy trimester is designated for ICD- 10-CM codes in the pregnancy, delivery and puerperium chapter.
Postoperative codes are expanded and now distinguish between intraoperative and post-procedural complications.
There are new concepts that did not exist in ICD-9-CM, such as under dosing, blood type, the Glasgow Coma Scale, and alcohol level.
Overall, the theme is specificity. Now can a coder, biller, registrar, or doctor memorize all their ICD10 codes as they likely have done for ICD9? Definitely not right away. Lucky for us a special set of files have been created called general equivalence mappings (GEMS). You can download the unedited data from https://www.cms.gov/ Medicare/Coding/ICD10/2016-ICD-10-CMGood and-GEMs.html
Look for “2016 General Equivalence Mappings (GEMS) – Diagnosis Codes and Guide.” Inside the zip file you will find a very informative PDF titled “Dxgem_ guide_2016.pdf.” This guide is a bit technical but worth the read as it will give you a great foundation in how ICD9 translates to 10.
Now I said “unedited” earlier for good reason. CMS has a very bad habit of formatting their data into text files which tend to be rather unusable. I cleaned it up for you into an excel spreadsheet (hint CMS…people use Excel…a lot) which you can download at www.mjhnews.com reference article ICD10 What a Gem. The spreadsheet consists of 4 tabs as shown in the screenshot below.
For those of you already using GEMS via a website, nice work you are ahead of a lot of us. But, did you know almost all website based translators out there are only giving you part of the story? There are 5 flags included inside the GEM file which are very important to the use of GEMS.
This spreadsheet is public domain just like GEMS and diagnosis codes to begin with. Use it to assist with updating your superbills or other forms, as resource for your schedulers, insurance verifiers, coders, billers, doctors, et al. The nice thing about a spreadsheet is it does not go down when your internet or that free website translator fails. Hope this helps.
My company has filed thousands of ICD10 claims already and good new some are even paying! Just stay focused and keep your head up or you might W220.2XD again.