1. What is ICD-10-CM?
ICD-10-CM is the International Classification of Diseases, 10th Revision Clinical Modification. This is a new/revised diagnosis classification system developed by the Centers for Disease Control and Prevention (CDC) for use in all United States health care settings. ICD-10-CM will replace the existing diagnosis code set, ICD-9-CM (International Classification of Diseases, 9th Edition, Clinical Modification, Volumes 1 and 2).
The U.S. Department of Health and Human Services (DHHS) has mandated that all HIPAA-covered entities must implement ICD-10-CM for use in standard electronic transactions (including but not limited to claims) for dates of service that occur on or after Oct. 1, 2014.
You should be planning and taking action now to be compliant by Oct. 1, 2014.
2. How does ICD-10-CM differ from ICD-9-CM for diagnosis coding?
ICD-10-CM is not just an update of ICD-9-CM codes. It is a restructuring of the diagnosis classification system with far more alpha numeric codes, expanded code lengths and narrative descriptions allowing for greater granularity. The following table illustrates the key differences:
||Number of codes
||Digit 1 is alpha (E or V) or numeric
||Digits 2-5 are numeric
||Digit 1 is alpha
||Digit 2 is numeric
3. Why does the health care industry have to implement ICD-10?
On Jan. 16, 2009, DHHS released the final rule mandating that everyone covered by the Health Insurance Portability and Accountability Act (HIPAA) must implement ICD-10 for medical coding on Oct. 1, 2013. On April 9, the deadline was extended to Oct. 1, 2014.
4. What steps should I take to prepare for ICD-10-CM?
Implementation planning for ICD-10-CM should begin immediately if it is not already underway, regardless of the size or function of your practice. ICD-10-CM implementation is not just a billing or information systems project. The organizational effect of the transition will be broad and deep.
An impact assessment should be completed as soon as possible to enable timely planning, development, education, testing and implementation. Several organizations provide implementation planning resources for ICD-10-CM.
5. Where can I find crosswalks from ICD-9-CM to ICD-10-CM codes?
Centers for Medicare and Medicaid Services (CMS) and the Centers of Disease Control and Prevention (CDC) have developed General Equivalence Mappings (GEMs) to show generally equivalent relationships between ICD-9-CM and ICD-10-CM codes.
However, the greater granularity and newness of ICD-10-CM compared to ICD-9-CM often result in one-to-many, one-to-none and sometimes many-to-many mappings in addition to one-to-one mappings. The GEMs are not to be used as a coding source but rather as a coding resource to help you understand the granularity of ICD-10. Read more about GEMs here.
6. What are General Equivalence Mappings (GEMs)?
GEMs are a tool that can be used to convert data (codes) from ICD-9-CM to ICD-10-CM (referred to as forward mapping) and vice versa (from ICD-10-CM back to ICD-9-CM, referred to as backward mapping). The GEMs are a comprehensive translation dictionary that can be used to accurately and effectively translate any ICD-9-CM-based data, including data for:
- Tracking quality.
- Recording morbidity/mortality.
- Converting any ICD-9-CM-based application to ICD-10-CM.
The GEMs are complete in their description of all the mapping possibilities as well as when there are new concepts in ICD-10 that are not found in ICD-9-CM. All ICD-9-CM codes and ICD-10-CM codes are included in the collective GEMs.
7. Is there a one-to-one match between ICD-9-CM and ICD-10-CM?
No, there is no one-to-one match between ICD-9-CM and ICD-10-CM due to a variety of reasons:
- There are new concepts in ICD-10 that are not present in ICD-9-CM;
- For a small number of codes, there is no matching code in the GEMs;
- There may be multiple ICD-9-CM codes for a single ICD-10 code;
- and There may be multiple ICD-10 codes for a single ICD-9-CM code.
8. Would there be an Instance where it is not necessary to use the GEMs?
It may not be necessary to use the GEMs when
- a small number of ICD-9-CM codes are being converted to ICD-10-CM codes, it may be quicker, easier, and more accurate to simply look up the codes in an ICD-10-CM book; and
- After ICD-10-CM is implemented on October 1, 2013, coders will use coding books or coding systems to code rather than using the GEMs.
9. Who can use the GEMs?
GEMs can be used by anyone who wants to convert coded data. Possible users of the GEMs include:
- All payers.
- All providers.
- Coding professionals to convert large data sets.
- Software vendors to use within their own products.
- Organizations to make mappings that suit their internal purposes or that are based on their own historical data.
- Others who use coded data.
10. Can I use the GEMs as a substitute for learning to use the ICD-10-CM?
GEMs are not designed as a substitute for learning how to use the ICD-10-CM. Providers’ coding staff will assign codes describing the patients’ encounters from the ICD-10-CM code books or coding systems. In coding individual claims, it will be more efficient and accurate to work from the medical record documentation and then select the appropriate code(s) from the coding book or coding system. The GEMs are a tool to assist with converting ICD-9-CM codes to ICD-10-CM codes.
11. Where can I find more information about ICD-10-CM?