In Part 8 we translated a policy by looking up each ICD-9 code in the policy in the “10-to-9 singles map with reverse index” and entered into our ICD-10 version of the policy the ICD-10 codes that were found there. We discovered that not all of our ICD-9 codes were found, and we put them on an “ICD-9 Orphan” list. Now we consider what to do with those ICD-9 codes.
Start by looking them up in the 9-to-10 singles table. If there are one or more entries for the ICD-9 code, it means one or more ICD-10 codes might be appropriate for the policy, given the definition of the ICD-9 code. The emphasis is on “might be” because the GEMs do not know the information in a patient’s chart used to assign the ICD-9 code. Those ICD-10 codes could contain additional meaning that may have been true for a patient, or not, and the ICD-9 code doesn’t specify either way. Continue reading
Donna: Sue, do you know what the UHDDS definition is for a significant procedure?
Sue: Of course! I hate to admit it but I was actually involved with coding issues in 1986 when the UHDDS revision occurred. The UHDDS definition of a significant procedure is a procedure that is one, surgical in nature, two, carries a procedural risk, three, carries an anesthesia risk, or four, requires specialized training. Why do you ask?
Donna: Well because some hospitals are assigning ICD-9 procedure codes for every procedure performed during an inpatient stay. Continue reading
In Part 7 you started with an ICD-9 policy list, and using the “10-to-9 singles map with reverse index” you found all the single ICD-10 codes whose meaning is included in one or more of the ICD-9 codes on your list. In other words, you found all the single codes in ICD-10 that can say what the codes on your ICD-9 policy list say. You wrote those down as a new ICD-10 version of your policy.
In the process, you may have come across … Wait. Is there a hand raised in the back of the class? Yes?
“When you had us write down each ICD-10 code we found using the reverse index, you did not have us write down the ICD-9 code it came from.” Continue reading
We are ready to start translating policies. The first step is easy to do, but difficult to believe in. When I “got it,” it was like one of those optical illusions where the cube suddenly turns inside out. I’ve watched other people see the light. I’m going to try to make that happen for you.
Reminding us of our objective: You have a list of ICD-9 codes we are calling a “policy.” This list means something. Whether or not you can express the meaning in English, there is a scientific way of inferring its meaning. If you take a large set of patient records, and you find each record which has one or more codes on the policy list, then the set of patients you have found defines the meaning of the policy. For example, if the list is a complete set of ICD-9 diabetes diagnoses, then the patients it finds are, insofar as possible with ICD-9, all those with diabetes. Your objective is to re-write the policy list in ICD-10 so that, if the same set of patients were to be coded in ICD-10, application of the list to those records would find the same set of patients. This is not always possible, but the recipe I’m advocating generally keeps the discrepancy rate below 1%. Continue reading
Sue: Donna – just think in nine months the I-10 baby is gonna be born!
Donna: Well, at least we won’t have to decide on a name.
Sue: Right! But, you know how first-time parents go to classes to practice before the baby comes?
Donna: Yes… What are you getting at?
Sue: I’m saying that hospitals should be developing plans to have their coding professionals practice coding their medical records well before this baby’s due date.
Donna: I totally agree! There are so many benefits to practicing. Continue reading
Guest blog by Charlie Bernstein
Remember when your Electronic Health Record (EHR) system was first implemented? Taking advantage of all of the new productivity tools, your organization probably built some customized problem lists. These custom problem lists made it possible to standardize on the codes you use for various departments, conditions, and regulatory submissions.
Now that the ICD-10 clock is ticking down, think back to the hours spent creating those custom lists in ICD-9. Since you developed the lists yourself, expecting an EHR vendor to convert them to ICD-10 for you isn’t really possible. Custom problems lists are just that, custom. How would they know what codes you want on the list for ICD-10? Continue reading
Having defined a list of ICD-9 codes with a collective meaning as a “policy,” we are now embarking on using the GEMs (downloaded from CMS.gov in part 5) to help build a policy translation system. The GEMs, by the way, can be used to underpin types of code translations other than policy translations, so be warned that we are not talking about any sort of GEM-based code translation now – only policy translation. We will get to other types later.
When you unzip the files you downloaded from CMS, you get two text files and some PDFs. We encourage you to read the PDFs. The two text files – one is a 10-to-9 map and the other a 9-to-10 map – are what we are going to be working with. Both have the same structure. Each line consists of a “source” code (followed by a blank for easy reading), a “target” code (again a blank), and five digits generally known as “the flags.” Continue reading
Less than ten months to go!
Donna: Sue, what would you say if I told you that last week I heard from a hospital that just identified some areas in their facility that use ICD-9 data.
Sue: So . . . what’s the big deal with that?
Donna: Well, this hospital completed their I-10 gap analysis at the beginning of 2013! Now these pockets of people using I-9 data in their facility are just surfacing. They’re a little rattled.
Sue: Yikes. That is a problem – hospitals have to decide what data needs to be translated to I-10 now. Continue reading
We’re still talking about converting policies – lists of ICD-9 codes or clusters that mean something that could be stated in English. These lists may be in documents, spreadsheets, the database tables that drive payment or quality assessment, or patient selection systems of any kind. In my last blog post we discussed recoding the policies, understanding what they are for and then re-creating the code lists in ICD-10. We noted some reasons why recoding may not be practical: the original intent of the policies may be obscure, or you may have more policies than your coding resources can handle, or both.
The MS-DRG grouper consists of about 500 interacting policies, APR-DRG has around 4,000, and our other groupers and editors have policy counts in that range. The meaning of each list (e.g. “minor bowel procedures”) is well understood and we have top-flight clinical analysts and physician advisors. However, we went to the trouble to develop and refine translation software for two additional reasons. First, we discovered that a clinical analyst with both an understanding of a policy’s purpose and a machine translation of its ICD-9 representation could produce a recoded policy in about a fifth of the time that it would take without the machine translation to start from. Continue reading
You’ve found a policy in ICD-9. You’ve figured out which Fiscal Year the codes are from and expanded any old codes that are now headers, so you are dealing with this year’s codes. You’ve correctly identified alternatives and, if any, clusters. You’ve carefully preserved leading and trailing zeros. You are now ready to convert your policy to ICD-10-CM/PCS.
There are two ways to do this: recoding and translation. Recoding entails understanding what the policy means and reconstructing that meaning using ICD-10. Translation is running each of the policy codes through maps to get ICD-10 codes and then consolidating and verifying the results. Continue reading