Researchers Link ICD-10 Shift to Financial Losses

John Commins, for HealthLeaders Media , March 17, 2014

The other idea is to have one of your data analysts pull the codes you use for your weekly and monthly reports and if you are actually running your reports off of ICD-9 codes pull those out of the reports and see which reports aren't going to make sense with ICD-10.

If they don't make sense you either have to redesign the report in ICD-10 or just realize that this is complex and some numbers are better than no numbers but this may be incorrect. Physicians and managers are used to uncertainty. Everyone knows you don't know the exact number of patients you are going to see next week.

We are providing tools to help them quantify what the [answers are] in reports and in financials and along those lines. Knowing that 20% of your reimbursement is going to be complex, maybe that is comfortable for you. Everyone has different risk tolerance. Maybe someone is comfortable with that. If not, then spend the hours and the staff time to drill down.

HLM: How does your translation tool work?

Boyd: We built that but it is derived from the government to help with the transition through the General Equivalent Maps. They have the files where they map from ICD-9 to ICD-10 in one file and in the second file from 10 back to 9. We did analytics about future implications. Like everyone else found out, it's hard.

From that we decided to continue to iterate along those lines the way to look at 9 and 10 codes in their totality in both directions so you could understand what the analytical impact was that is how we developed the analysis tool.

Previous guidance for 9 and 10 from the AMA and other agencies told people to only go in one direction, forward or backwards. When we followed their guidance we got conflicting data. The reports changed, which was the impetus to begin this tool. We weren't looking to analyze the mappings for all of them. We took the highest costs and the most complex ones. There is in GEMs something like 150,000 relationships. This is a small project.

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2 comments on "Researchers Link ICD-10 Shift to Financial Losses"

Dan Toren (3/18/2014 at 2:32 PM)
Great questions Susie. From 3M website:"How 3M became the ICD-10 leader Under contract with the Centers for Medicare and Medicaid Services (CMS), 3M designed and developed the ICD-10 Procedure Coding System (ICD-10 PCS) and the General Equivalence Mappings (GEMs). 3M also completed the initial conversion of the CMS MS-DRGs to ICD-10." Disclaimer: we have nothing to do with 3M. However, anticipating the angst of October 1st, we've developed and recently released an app that may help alleviate the anxiety related to the ICD-10 implementation - ICD10Doc. And yes, we have actually used GEM for mapping between ICD-9 and ICD-10. is intended especially for the small practices that don't have the support or budgets of a hospital HIM department. You can check it out at Your feedback would be much appreciated Thanks Dan

Susie/Internal Medicine Practice Administrator (3/17/2014 at 10:54 AM)
I am still trying to figure out why there is the switch to ICD-10 in the first place. Real facts, not just government or insurance company public statements. Who wrote/created the GEMs? Is this evidence based medicine? When the author states that the maps may be wrong, most practices simply don't have the time or knowledge to create new algorithms. Is this tool for oncology only? Is this "map" ubiquitously used by Medicare and Commercial insurance companies? In other words, are they sharing the same GEMs? Any assistance would be greatly appreciated. Thank you in advance.




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