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BEST PRACTICES TO ESTABLISH PRECISE MAPPING BETWEEN OLD AND NEW ICD CODE SETS
Just as drivers must select the proper road map for planning a trip, healthcare organizations must also manage their code translation process through a defined road map.
THIS ARTICLE PROVIDES essential guidance to healthcare organizations on adopting best practices that will help to establish a precise mapping between the old and new ICD code sets. These best practices, based on the author's experience from working with multiple healthcare organizations, also help to ensure proper applicability of the mapped codes across various business domains and long-term business requirements- in essence, paving the way to a successful ICD-IO implementation.
The implementation of ICD-10-CM/PCS is a significant opportunity for healthcare organizations to upgrade the quality of healthcare transactional data. It is also a big, complex amendment in the area of clinical coding. Even if organizations decide to move natively in ICD-IO through strategic system upgrades, mapping between ICD-9 and ICD-IO is still a vital cog in their ICD-IO implementation cycle. And even if not in a production environment, static one-time mapping is an absolute requirement for organizations in many of their business situations, such as matching historical data for member cost analysis, care management program designing, supporting certain claims adjudication decisions, or analyzing financial neutrality prior to stepping into the ICD- 10 world. Finally, there are the challenges of upgrading legacy platforms deemed to be on the brink of obsolescence within the next couple of years, as their strategic upgrades are complicated and both time- and cost-intensive.
The General Equivalence Mappings (GEMs) provided by the Centers for Medicare and Medicaid Services (CMS) have been a starting point to assist organizations in transitioning from ICD-9 to ICD-IO. Prudent organizations are attempting to simplify the GEM complexities to derive custom maps as defined business uses. However, the mapping exercise is not that simple- it requires robust governance, defined processes and frameworks, incorporation of business decisions, and effective management of the translated codes. Organizations that overlook any of these in their mapping exercise may be at significant risk of impacting themselves negatively from a potential productivity, financial, and compliance standpoint.
Understanding ICD-10 Mapping
The exercise of ICD- 10 mapping is associated with a number of terms, such...