ICD-10: Translation 101

Never let it be said that the implementation of ICD-10 has not been exciting.

ICD-10 is still a critical project that will continue to require our full attention. One of the areas of implementation that seems to create the most anxiety is translation. So let’s talk about it.

You’ve probably heard about the concept a hundred times and in several ways, such as mapping, crosswalking, translating, converting, etc. But what does it really mean? And what is the best verb to describe it? I offer, for your consideration, a breakdown of the verbs that are associated with the act of identifying the ICD-10 counterpart for a given ICD-9 code, or vice versa:

• Mapping – Using a starting point (ICD-9 code) and plotting an end point (ICD-10 code).

• Crosswalking – Identifying a code that is the equivalent of a starting code (ICD-9 or ICD-10).

• Converting – Changing policies, processes, and systems from current ICD-9 logic to ICD-10 logic, including the codes themselves.

• Translating – Using all methods available (including mapping, crosswalking, and converting, along with review of business requirements, clinical equivalence and appropriateness, and standard coding methodologies and guidelines) to identify the equivalent code or codes in ICD-10.

Many people use these terms interchangeably, but I am here to offer a little perspective, having done all of the above with my own two hands. These are not the same actions, but each can be a step in a much larger process that we all must embark upon if we are to implement ICD-10. 

We can’t use just one technique and call it a day. Case in point: we have all heard of the general equivalence mappings, or GEMs, that were developed by the Centers for Medicare & Medicaid Services (CMS) and 3M and released for free to the public for use in the transition to ICD-10. These mappings are also the standard “crosswalk” as required by the Patient Protection and Affordable Care Act. But these mappings, of which only a small percentage could be considered an actual “crosswalk,” are only a starting point in a much larger process. Look at this statement found in the GEMs User’s Guide:

“There is no simple ‘crosswalk from I-9 to I-10’ in the GEM files. A mapping that forces a simple correspondence — each I-9 code mapped only once — from the smaller, less detailed I-9 to the larger, more detailed I-10 defeats the purpose of upgrading to I-10. It obscures the differences between the two code sets and eliminates any possibility of benefiting from the improvement in data quality that I-10 offers. Instead of a simple crosswalk, the GEM files attempt to organize those differences in a meaningful way, by linking a code to all valid alternatives in the other code set from which choices can be made depending on the use to which the code is put.”

A simple solution is not always the best solution, and the translation process is anything but simple. In fact, it is a dynamic process that can change between business areas based on the use of codes or code data. Not everyone uses the codes in a standard way. If we’re completely honest, not everyone applies the codes according to the official coding guidelines. What we code is wholly determined by our understanding of the codes and how to apply them. The same is true for how codes are used within a payor system and how claims processing and adjudication rules are coupled with codes in the systems. Therefore, a standard “crosswalk” is not a solution based in reality in today’s healthcare environment.

But we shouldn’t feel defeated or start looking at ICD-10 implementation as some sort of insurmountable obstacle. Instead, let’s set aside our frustrations, breathe, and take a moment to assess what needs to be done to translate our ICD-9 world into the language of ICD-10. Here are some tips to get you started:

1. Assess and prioritize what requires modification. Because the implementation clock is ticking, don’t waste your precious time on efforts that can wait until after the implementation date has come and gone. Focus on what absolutely needs to get done in time for testing and ahead of implementation.
2. Take stock of your internal coding expertise. Leverage the human resources you have to help in any translation efforts you may have going on, regardless of whether they are expert coders or know “just enough to be dangerous.” Get started and assess where your gaps in knowledge are.
3. Identify your clinical resources. Clinical knowledge may be all you need to address any gaps that can’t be filled by your coding expertise. Sometimes it’s only a small piece of the puzzle that will yield the solution.
4. Take advantage of free resources – GEMs and ICD-10 manuals are available free of charge through CMS (www.cms.gov/Medicare/Coding/ICD10) along with the new Road to 10 provider portal (www.roadto10.org). Start by familiarizing yourself with the ICD-10 code set using the manual, and then you can begin any translation by looking up your ICD-9 codes in the GEMs. Use the manuals, which provide coding guidelines, to identify any codes that the GEMs do not identify. Remember, the GEMs are only an approximation.
5. Align your translations with your business requirements. Translation does not end with the identification of the appropriate ICD-10 codes. Review your translations in the context of your business requirements. Some ICD-10 codes may not be applicable, and there may be additional gaps that will need to be addressed.
6. Create a review and approval process. Employ more than one set of eyes to review the translations, ensuring that all solutions are as complete and accurate as possible. Formalize the approval process by identifying the owner of the process, and make sure he or she is responsible for approving any translation solution along with when the approval was given.
7. Archive your translation solutions. Who knows what will be needed in terms of documentation, post-implementation, so make sure you have all solutions and their related information archived and available for future reference.

Don’t sweat the small stuff. And don’t bite off more than can be chewed properly before October 1, 2015. But do get started sooner rather than later!

About the Author

Mandy Willis is a Certified Coding Specialist and AHIMA Approved ICD-10 Trainer with 15 years of experience in the healthcare industry. She has worked in the small physician practice environment, commercial payer and Medicare and Medicaid. Currently, her focus is on assisting all sectors of the healthcare industry in making the transition to ICD-10.

Contact the Author

willis.m@ghc.org

http://icd10monitor.com/enews/item/1162-icd-10-translation-101

Why a great ICD-10 steering committee is so important

Author Name Jennifer Bresnick   |   Date June 5, 2013

You can order all your coding workbooks, schedule your physician lectures, hand out ICD-10 lollipops by the dozen, and nag your vendors until you’re blue in the face, but the chances of your hospital being fully prepared for ICD-10 without a strong project plan and central leadership are slim at best.  The ICD-10 steering committee is a critical component of a successful conversion plan, and is the best defense against important initiatives slipping through the cracks as hospitals scramble to coordinate end-to-end testing, vendor updates, physician and coder education, and employee buy-in to one of the most frazzling and disgruntling transitions in healthcare.

Why should my hospital have one?

The purpose of the steering committee, executive leadership board, project plan commission, or whatever you want to call it, is to provide a centralized authority to establish a direction and achieve consensus when big decisions have to be made.  ICD-10 is a project with a very firm deadline.  Plain and simple?  You won’t get paid for ICD-9 codes used for services provided on or after October 1, 2014. With the majority of hospitals dragging their feet on implementation, and the compliance date approaching quickly, the only way to galvanize a reluctant organization with hundreds of moving parts is by establishing a board that can plan, delegate, and hold all parties responsible for their various tasks.

“It’s going to take longer than people think,” warns AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, FACHE.  “It really does take a village.  What we’re finding that there are so many systems that are impacted by this coding change that you have to work together with your entire organization to get you where you need to go.”

Who should be on the committee?

While it’s definitely important to get the thumbs-up from the executive leadership of the hospital, the steering committee shouldn’t just consist of your C-suite.  It is vital to bring in representatives from the clinical side, recruit physician champions who are enthusiastic about the project, and make sure you’re keeping your coding staff and IT wizards informed about your progress and concerns.

Project management is the key to a successful transition, and having strong, experienced managers to lead the charge can make all the difference.  “There are just so many projects that contribute to your overall ICD-10 approach,” explains Bonnie Cassidy, MPA, RHIA, FAHIMA, FHIMSS, former President of AHIMA who now works with Nuance.  “But within each one of those, you need people who are good, strong, solid project managers.  You want people who get up in the morning and think project management.  They’re the ones who are going to be very disciplined, very structured.  So if there’s any slippage in any of those projects, they’re going to know right away.”

A steering committee that represents all the major players in the ICD-10 transition – physicians, coders, financial staff, the IT department, and executive decisions makers – can secure the willingness of participants and craft a targeted, encouraging message for employees who may be hesitant to embrace the changes that ICD-10 will bring.

What should the committee do?

A steering committee should set up sub-committees in charge of the major aspects of ICD-10: coder training, physician education, and technical testing and compliance projects.  CMS has released a series of checklists and timelines for each of these areas to help guide organizations to the finish line.  The committee should establish benchmarks and meet monthly with representatives to ensure that goals are being met in a timely manner.

Communication is one of the biggest challenges of the transition, and the need for hospital-wide buy-in shouldn’t be underestimated.  Appointing physicians or nurses as advocates to help other clinical staff understand what will be required of their documentation habits can help ease fears about massive changes to workflow or patient notes. Checking in with the budget department will also be crucial, as the ICD-10 transition is expected to have a major impact on revenue cycles, and all that staff education is an expensive ordeal.  Putting your hospital’s CFO on the committee will ensure that there are no monetary surprises at the end of the day.

Make sure that the committee meets regularly and stays active and engaged in the entire ICD-10 process, including the weeks and months after October 1.  Your ICD-10 process isn’t going to end on the implementation date: no one really knows what the impact will be on productivity and claims processing, so you’ll need to keep making adjustments if your coders can only do half as much work as they get used to the new system.

There’s no doubt in anyone’s mind that ICD-10 is going to be a headache.  But a strong steering committee that takes charge, engages with stakeholders, and makes the tough decisions can help mitigate the pain.  If you’re one of the 25% of hospitals that haven’t taken this vital step yet, consider recruiting some leaders right away in order to prevent a big disaster next fall.

ICD-10 implementation: Myths and facts from CMS

Author Name Jennifer Bresnick   |   Date May 28, 2013   

Scary stories from Canada, dire warnings from the AMA, and a stream of experts alternately comforting providers and warning them to hunker down and prepare for the worst are leaving providers confused and conflicted a mere seventeen months beforeICD-10 implementation on October 1, 2014.  In response to the jumbled avalanche of information hitting providers at a time when the industry is in the midst of several massive changes, the Centers for Medicare and Medicaid Services (CMS) has developed afact sheet identifying several myths about ICD-10 and clarifying the truth behind these common misconceptions.

Myth: Not everyone has to switch to ICD-10

Fact: All HIPAA-covered entities, including physicians and hospitals, are mandated to switch to ICD-10 in 2014.  But that doesn’t include every single type of organization that currently uses ICD-9.  Worker’s Compensation and auto insurance companies, for example, use ICD-9 codes but are not required to make the leap to ICD-10. But it’s in their best interests to do so, says CMS, since physicians and hospitals will be using the newer codes.  The increased detail and specificity will be just as useful for worker’s comp as it is for the emergency department, and CMS will work with non-covered entities to help them make the transition.  State Medicaid Programs will also receive CMS help to ensure that they will meet the deadline.

Myth: Everything is going to get prohibitively more complicated

Fact: ICD-10 has a lot of codes.  140,000 of them, to be exact.  But just as increasing the number of words in a dictionary doesn’t make it harder to use, the greater number of ICD-10 codes won’t significantly affect the complexity of coding, CMS explains.  Electronic decision support tools and organized code books will make finding the right code easy, and the new logical structure of ICD-10 will help coders find exactly what they’re looking for.

Non-specific codes are still available for use if supported by clinical documentation, and much of the detail necessary for ICD-10 coding is already present.  Providers do not need to perform unnecessary diagnostic tests just to get to the most specific code that exists in the code book.  Superbills based on ICD-10-CM won’t necessarily be any longer or more complicated than ICD-9 superbills, and codes can be crosswalked to help the conversion process.

Myth: I can just use GEMs for coding medical records

Fact: The General Equivalence Mappings (GEMs) are a handy tool for converting large amounts of data from ICD-9 to ICD-10, and are intended to help update payment systems, risk adjustment logic, quality measures, and research databases by mapping one code set to the other.  They aren’t a one-to-one solution for coding an individual clinical chart.  Mapping isn’t the same as coding, CMS warns, because the GEMs don’t allow for the selection of the most accurate and applicable ICD-10 code.

The GEMs are free of charge and available to any provider who wishes to use them, but code books, which are available in physical hard copies and electronic editions, should be used to deal with individual patient charts.

Myth: CMS is going to push the conversion date back again

Fact: No, they won’t!  CMS and HHS currently have no plans to move the date or extend the conversion process.  Any provider who is not ready to use ICD-10 codes starting on October 1, 2014 will not be reimbursed for services performed on or after that date if they are coded in ICD-9.  The one year delay from 2013 to 2014 has already caused significant disruptions in the planning process, but CMS has repeatedly said that the date will not budge again.

Providers should take advantage of CMS resources, such as detailed timelines andupdated implementation guides, in order to plan their transition.