Healthcare Solutions | ICD-10 Code Maps

With the move to ICD-10 rapidly approaching, a major task health plans face is updating their systems, policies, and processes to recognize ICD-10 codes and accurately handle transactions. By far, the biggest undertaking during this transition will be mapping the ICD-9 codes in use today to the ICD-10 codes that replace them. It's a far-reaching effort that will impact several areas of every healthcare entity's business—claims adjudication, medical policies, medical management, actuarial systems, provider contracting and pricing modules, just to name a few.

Fortunately, healthcare organizations have a good starting point: the General Equivalency Maps, or GEMs. Most will use ICD-10 code maps for a variety of purposes, such as identifying which codes will define a specific policy, disease management area, or benefit category—always important for native updates to back-end systems. Another use is identifying the specific codes used to analyze data before and after the implementation date to ensure accurate conversion of historical data to a consistent code set.

Regardless of the purpose of the map, it's critical to have a complete perspective during the mapping exercise. Much like a geographically flat map only shows the distance between two points and not necessarily the difficulty of the terrain, GEMs are a great starting point, but they don't always include all the information a healthcare organization will need to complete its migration.

Besides the possibility of not having all the codes an entity must consider, GEMs simply provide a list of related codes without providing critical details that explain how and why the codes are related, or where they differ. For healthcare entities, this means they will have to spend a significant amount of time and effort to evaluate those differences. They will also need an effective tool to assist them in identifying the differences in medical concepts between codes or risk negative impacts to financial neutrality and remediation efforts.

The Edifecs ICD-10 Code Management tool provides this additional perspective. It assists the coder in quickly identifying the differences in medical concepts between codes and includes the capability for the coder to document the reasoning behind the mapping decision. Coders can also add valuable ‘includes' and ‘excludes' information to aid in the mapping process.

Edifecs ICD-10 Code Management can dramatically reduce the resources required to complete the mapping and — at the same time — greatly increase the likelihood that each mapping choice is both accurate and deliberate. Using this tool, healthcare entities can be sure they are using the new ICD-10 code set to its fullest benefit.

- Best wishes,
Kristine Weinberger,
Senior Healthcare Business Consultant

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