ICD-10 mapping efforts need organization to succeed

Establishing mapping to bridge the gap between the ICD-9 and ICD-10 coding sets is no easy task for hospitals and other provider organizations. A keen understanding of the process, as well as an organized plan of attack, are necessary for ensuring that such efforts are accurate, ICD-10 consultant atInfosys Public Services Suman De wrote in the June edition of the American Health Information Management Association's Journal of AHIMA.

"The transition to ICD-10-CM/PCS will require substantial improvement in existing documentation practices, including policies, rules and clinical charts, to ensure that the definitions help consistent clinical interpretation of the new codes when mapped from their precursors," De wrote. "The reason for such complexities is that we are moving from a relatively simpler code set to an inherently more complicated and detailed code set."

De outlined several steps for a successful mapping effort. Among his suggestions, De said providers must:

  • Take note of which business processes and systems use ICD-9 to get a sense of the task at hand and to figure out where mapping truly will be necessary
  • Create a "core mapping team" that spans all stakeholders to ensure multiple opinions are heard and considered
  • Conduct a gap analysis between forward and backward General Equivalence Mappings (GEMs) files to create a master mapping list
  • Establish an "absolute mapping guideline" to ensure mapping consistency. Within such a guideline, GEMs files don't necessarily need to be taken as gospel and can be adjusted to fit a facility's needs.
  • Validate and maintain the maps

De's suggestions echo sentiments made last June by WellPoint Vice President of Business, IT strategy and Execution Leadership Ian Bonnet at an event in Washington, D.C. Bonnet called GEMs a good starting point but added that "it's not the end-all-be-all" for ICD-10 fluency.

In an interview with FierceHealthIT in April, Bonnet added that he thinks trusting relationships between payers and providers also will be key for smooth ICD-10 transitions.

"It's funny; if you think about the normal relationship between payer and provider, it's not necessarily contentious or adversarial, but it does tend to be opposite sides of the table," Bonnet said. "We literally sit down with our provider partners and say 'Look, if you fail, guess what? We fail, too.'"

To learn more:
- here's the Journal of AHIMA article

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