September 12, 2013 • Issue No. 6

•  ICD-10 Mapping and GEMS: New Updates•  New ICD-10 Tools for OMA Members•  Mark Your Calendar for Spring 2014 Educational Programs•  Examples of ICD-10-CM 2014 Updates•  Code Comparisons & ICD-10-CM Hierarchy•  ICD-10-CM Breakdown

ICD-10 Mapping and GEMS: New Updates

Overall,  ICD-10  contains  greater  than  140,000  codes;  the  CM  version, used  for professional  coding, contains approximately 68,000 codes, and the  PCS  version,  used  in  hospitals,  contains  over  72,000  codes.    The world-wide ICD-10 was developed and is owned by the Word Health Orga-nization.  Most countries develop an adaptation specific to their country.  In this country, both the CM and the PCS versions are adaptations specific to the United States.

As part of the implementation process, CMS developed GEMS, which is an abbreviation for General Equivalence Mapping System.  It is the purpose of this tool to provide a crosswalk, or mapping system, between the more generalized codes in ICD-9 to the specificity of codes in ICD-10.

For example, the ICD-9 code for Rheumatoid Arthritis (714.0) has over 80 crosswalks in ICD-10 as identified by GEMS.  This is to allow for a) different types and manifestations of rheumatoid arthritis; and b) locations, including laterality where indicated.

GEMS can “forward map” from ICD-9-CM to ICD-10-CM, and it can also “backwards map”  from  ICD-10-CM  to  ICD-9-CM.    There  are  also  some codes for which there is no cross walk from ICD-9-CM to ICD-10-CM, or backward from ICD-10-CM to ICD-9-CM.  Examples of these are the fol-lowing:

Code Set Code Description CommentICD-10-CM Y71.3 Surgical instruments,

materials andcardiovascular devices (including sutures)associated with  adverse incidents

No ICD-9 crosswalk

ICD-9-CM 89.8(procedurecode)

Autopsy No ICD-10 crosswalk

Several years ago, CMS indicated that for ease of training, there would be a partial  freeze of both  ICD-9 and ICD-10 codes.   This has held  true  for ICD-9.  No new codes have been added since October 1, 2011.

Treading the Transition to ICD-10Nov. 13 • Oregon Convention Center, Portland

Hear from physician experts, the AMA, CMS and other payers about the challenges and opportu-nities offered by ICD-10, what  is being done to pave the way for the changeover, and how you and your practice can best prepare for it. Learn about existing tools and resources that are avail-able now to help practices through all phases of the transition. 

Featured Speaker  Joe Nichols, MD,  is a board certified orthopedic surgeon with a wide range of experience  in  health  information  technology  on the provider, payer and vendor sides of business.

Treading the Transition to ICD-10 is held in con-junction  with  the  cHealth Innovation Sympo-sium,  a  coordinated  health  care  and  health  IT transformation event Nov. 13 through 15. Learn more and register for Treading the Transition to ICD-10 and the cHealth Innovation Symposium at www.chealthinnovation.com.

Discounted 2014 Coding Books

To  help  you  in  your  implementation  and  plan-ning, OMA members may  purchase AMA  cod-ing books and other publications at a discounted rate  at  www.theOMA.org/store.  Publications including  the  ICD-10-CM  2014:  The  Complete Official  Draft  Code  Set,  ICD-10-CM  Mappings 2014: Linking ICD-9-CM to All Valid ICD-10-CM Alternatives, Advanced Anatomy and Physiology for ICD-10-CM and more are available now. To order publications via e-mail or fax, or for more information, please contact Kimberly Weitman at (503) 619-8000 or kimberly@theOMA.org.

Other ICD-10 Resources

OMA: www.theOMA.org/ICD-10

CMS: go.cms.gov/Rn1hgl

Noridian: http://bit.ly/O0Iw2S

AMA: http://bit.ly/edC7lt

ICD-10ICD-10Managing Your Transition toManaging Your Transition to

However, as we come closer to implementation of ICD-10 (we are currently only around 400 days until the transition date of Octo-ber 1, 2014), the ICD-10 codes and crosswalk tools come under greater scrutiny.  Based on stakeholder input (carriers, providers, hospitals, etc.), CMS has developed an updated version of GEMS to provide greater clarity and more options in the crosswalks.  Many have been developed to create closer matches to existing ICD-9 codes.  Depending on your specialty, the changes may answer some of the mapping questions you may have and provide a measure of simplification to your crosswalk process.

On review, the update includes the addition of codes, more specific descriptions, and deletions of some codes in favor of greater specificity.  This is much like we experienced each year with ICD-9-CM, except to a smaller extent.

Many of you have already purchased earlier versions of ICD-10 code books and mapping tools.  Does this mean that if you have an earlier version of ICD-10 and GEMS that it will need to be updated?  Yes, because, just as we’ve experienced on a yearly basis in the past with ICD-9, there are additions, deletions and changed descriptions.  Although you absolutely want the most up-to-date books when you begin training to actual codes, earlier versions of ICD-10-CM can still help you make viable implementation decisions.

Does this mean your previous version of ICD-10-CM and/or mapping book is of no value?  Not necessarily.  Most physician offices are still formulating their ICD-10-CM implementation plans.  Most groups are still learning the concept of ICD-10-CM, rather than beginning to memorize the codes themselves.

One of the pre-implementation concepts we teach is that your practice needs to evaluate the ICD-9-CM codes you use most often and then determine how many ICD-10-CM codes they cross walk to.  The higher the volume of applicable crosswalks, the more in depth the implementation will be.  

For example, if the majority of codes used in your practice have a single crosswalk, there are fewer codes to learn and work with than if the majority of codes in your practice have 50 or more crosswalks.  Both the new version and the earlier version of ICD-10-CM can help define that for you.

The following table shows the current percentage of ICD-9 codes with singular or multiple matches in ICD-10  For example, 3 percent of the ICD-9 codes have no equivalent code in ICD-10 and 18 percent of the ICD-9 codes have an approximate match with multiple choices.

Mapping Categories ICD-9 to ICD-10 No Match  3.0% 1-to-1 Exact Match  24.2% 1-to-1 Approximate Match with One Choice  49.1% 1-to-1 Approximate Match with Multiple Choices  18.7% 1-to-Many Match with One Scenario  2.1% 1-to-Many Match with Multiple Scenarios  2.9%  

Updating GEMS is a positive step in our transition process, both in identifying closer matches to some of the codes in ICD-9, and in providing us with more exact code choices.

As you move forward with your implementation preparations, GEMS is an invaluable tool for your practice.  It will help you identify the depth of change your practice will experience and the extent of training needed.  It will also assist you in training.  

Remember to consider mapping as a tool in your arsenal - but not the only tool.  A crosswalk system will help you efficiently iden-tify an ICD-10 equivalent of some codes you may have memorized in ICD-9. But a crosswalk alone can’t necessarily help you understand the meaning behind the codes, their prioritization, or when additional codes are required.  That comes with learning the codes, their meaning, the coding conventions, and the coding hierarchy, for itself.  Take advantage of all opportunities offered!

New ICD-10 Tools for OMA MembersSimple Solutions ICD-10 Transition Software and Toolkit are fast, easy, and affordable ways to help practices ensure a successful transition to ICD-10. 

The web-based ICD-10 Transition Software  converts  ICD-9  codes  to  ICD-10  in  seconds. This General Equivalence Mapping System tool is accessible anywhere, from any computer and features multiple code lookups, print capabilities, the ability to save favorites and to create flash cards to serve as training tools for your entire staff.

The ICD-10 Transition Toolkit is a user-friendly, comprehensive step-by-step roadmap to the ICD-10 transition. It works as a “vir-tual consultant” and includes all the tools needed for a smooth transition. Suitable for any size practice or specialty, covered topics include policies, procedures, processes, relationships with other organizations and IT. 

OMA members and their staff receive a significant discount on the transition software and toolkit; save even more when you pur-chase both. Learn more and order these valuable resources today at www.cpticdpros.com/OMA.

Mark Your Calendar! ICD-10-CM Educational Programs Coming in Spring 2014 • ICD-10-CM Training for Coders 1 & 2  • ICD-10-CM Training for Providers  • ICD-10-CM Training for Clinical Staff • Clinical Documentation      • ICD-10-CM Training for Coders by Specialty webinar series

Watch for more information and registration coming soon to https://theOMA.inreachce.com.

Examples of ICD-10-CM 2014 Updates

Description ICD-9-CM Code Original ICD-10-CM Code 2014 ICD-10-CM CodeScreening for gout V77.5 Z13.0 Z13.89 

(encounter for screening for other disorder)

Cerebral degeneration in childhood unspecified

330.9 G94 G31.9  (degenerative disease of nervous  system, unspecified)

History of mental disorder unspecified V11.9 Z65.8 Z86.59 (personal history of other mental and behavioral disorders)

Substance abuse treatment counseling HZ30ZZZ HZ30ZZZ (individual counseling for substance abuse treatment, cognitive)

HZ40ZZZ(group counseling for substance abuse treatment, cognitive)

Sprain of septal cartilage of nose 848.0 S03.1XXA S03.8XXA (sprain of joints and ligaments to other parts of head, initial encounter)

Code Comparisons & ICD-10-CM Hierarchy

ICD-9-CM Code ICD-10-CM Code OptionsCode Description Code Descriptions912.4 Superficial injury of shoulder

and upper arm; insect bite, nonvenomous, without mention of infection

S40.261A Insect bite (nonvenomous) of right shoulder, initial encounter

S40.261D Insect bite (nonvenomous) of right shoulder, subsequent encounter,  S40.261S Insect bite (nonvenomous) of right shoulder, sequela

S40.262A Insect bite (nonvenomous) of left shoulder, initial encounter S40.262D Insect bite (nonvenomous) of left shoulder, subsequent encounter,  S40.262D Insect bite (nonvenomous) of left shoulder, sequela S40.269A Insect bite (nonvenomous) of unspecified shoulder, first encounter S40.269D Insect bite (nonvenomous) of unspecified shoulder, subsequent encounter S40.269S Insect bite (nonvenomous) of unspecified shoulder, sequela S40.861A Insect bite (nonvenomous) of right upper arm, initial encounter S40.861D Insect bite (nonvenomous) of right upper arm, subsequent encounter S40.861S Insect bite (nonvenomous) of right upper arm, sequel S40.862A Insect bite (nonvenomous) of left upper arm, initial encounter S40.862D Insect bite (nonvenomous) of left upper arm, subsequent encounter S40.862S Insect bite (nonvenomous) of left upper arm, sequela S40.269A Insect bite (nonvenomous) of unspecified shoulder, first encounter S40.269D Insect bite (nonvenomous) of unspecified shoulder, subsequent encounter S40.269S Insect bite (nonvenomous) of unspecified shoulder, sequela

ICD-10-CM Breakdown

Problem Generalized Area Options Laterality Options Encounter OptionsInsect bite (nonvenomous)

Shoulder Upper Arm Right Left Unspecified Initial  Encounter

Subsequent Encounter

Sequela

S40. 25 86 1 2 9 A D S

© 2013 Oregon Medical Association - 11740 SW 68th PKWY, Portland OR 97223 - (503) 619-8000