Is Use of GEMs to Prepare for ICD-10 Wise? |


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In credentials for ICD-10, a sovereign supervision grown GEMs, a interpretation apparatus to assist in converting information from ICD-9 to 10, and clamp versa. But leaders of outsourced coding, auditing and consulting services organisation HRS contend a apparatus has stipulations and a use should be delicately considered.

The Centers for Medicare and Medicaid Services and Centers for Disease Control, with contention from a American Hospital Association and American Health Information Management Association, combined GEMs, that is brief for General Equivalence Mappings. The agencies, in superintendence accessible here, explain that GEMs are crosswalks “as they yield critical information joining codes of one complement with codes in a other system. The GEMs are a extensive interpretation compendium that can be used to accurately and effectively interpret any ICD-9-CM-based data.”

This includes information for tracking quality, recording morbidity/mortality, calculating reimbursement, and converting any ICD-9-CM-based focus to ICD-10-CM/PCS such as remuneration systems, remuneration and coverage edits, risk composition logic, peculiarity measures, and investigate applications involving trend data, according to a guidance.

“Mapping from ICD-10-CM and ICD-10-PCS codes behind to ICD-9-CM codes is famous as behind mapping,” a superintendence continues. “Mapping from ICD-9-CM codes to ICD-10-CM and ICD-10-PCS codes is famous as brazen mapping. The GEMs are finish in their outline of all a mapping possibilities as good as when there are new concepts in ICD-10 that are not found in ICD-9-CM. All ICD-9-CM codes and all ICD-10-CM/PCS codes are enclosed in a common GEMs.”

That’s not how Wendy Coplan-Gould, boss during HRS, views a comprehensiveness of GEMs, that she calls some-more of a concept, while codes are specific. If an insurer is reimbursing a provider formed on a ubiquitous formula and a provider submitted a specific code, “there is going to be a lot of activity post-reimbursement to quarrel payments,” she predicts.

That’s since GEMs in many cases are incompetent to allot specificity so will interpret to a general code, explains Barbara Hinkle-Azzara, clamp boss of HIM operations during HRS. ICD-10 coding is so specific that payers could cavalcade down and ask providers for some-more information before profitable claims, or payers could confirm to compensate for specific services regulating a handful of germane ICD-10 codes. That means that providers who contention claims with a many suitable ICD-10 codes competence get reimbursed formed not on a comparison codes, though on another set of codes a payer selected, that expected would impact reimbursement.

While many insurers–particularly Medicaids and Blues–are going directly to ICD-10 for adjudication, a large though different series of payers will accept ICD-10 codes though return behind to ICD-9 for adjudication. Hinkle-Azzara advises providers to exam with several of their vital payers to know how they will adjudicate–and ask when reaching out to exam if a payer expects to repay formed on translating behind to ICD-9. Even if a payer refuses to test, ask if they have a ICD-10 formula set in their adjudication complement or are mapping behind to ICD-9, she adds.

Many providers have finished or are building clinical support alleviation programs to take full advantage of a specificity of ICD-10 formula sets to get optimal suitable remuneration and urge a correctness and utility of information for analysis. But GEMs might automatically allot a formula that is not as specific as what a provider could be selecting. For instance, a suitable ICD-10 formula might be for “chronic or determined atrial fibrillation,” though if coding assignment is finished formed usually on GEMs, a formula that is mapped is “unspecified atrial fibrillation,” says Hinkle-Azzara.

HRS recommends that providers use local coding practices to allot a many suitable ICD-10 codes to safeguard that a coding reflects what is documented in a medical record. Assigning a codes formed on support rather than a GEMs will improved support accurate remuneration predictions. But it isn’t only remuneration expectations that can be influenced if providers are not natively assigning a specific ICD-10 codes, Wendy Copland-Gould says. If codes are blank or are non-exclusive as a outcome of regulating a GEMs, information collected and analyzed for astringency of illness and risk of mortality, among other indicators, could be negatively influenced as well. That could lead an classification to have false information about a impact of their transition to ICD-10.

Regardless of either an classification uses GEMs or chooses to natively formula to collect information for their initial ICD-10 analysis, it is needed that they start or continue to perform twin coding during some indicate in allege of a ICD-10 correspondence date, Hinkle-Azzara counsels. “Dual coding, tangible as a focus of both ICD-9 and ICD-10 formula sets to a patient’s health record, regulating a coding conventions and coding discipline that are specific to any formula set, is resource-intensive,” she acknowledges. But it is positively required to capacitate providers to be prepared to truly know where they mount in regards to suitable remuneration and information stating when ICD-10 becomes a reality.


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Unbelievable ICD-10 Codes | HealthWorks Collective


ICD-10: Coming to a Hospital Near You (eventually).

The hassle of adopting ICD-10 has only just begun for some – others might imply that they’ve been waiting for it for years, having started preparations many moons ago. In case you need a mini-lesson, ICD-9 (the current coding system used by medical coders and billers) is soon to be replaced by ICD-10 which boasts as many as 65,000 codes – that’s 8 times the current number coders are using. Think of ICD codes as the short hand form of longer, medical terminology filled language. By assigning a series of numbers to not just the medical diagnosis (say, diabetes) but also numbers in certain placements that represent the onset, duration or other qualities of the disease (acute or chronic) medical coding of records and subsequent billing of insurance companies has been made more streamlined. Of course, since we now are going to see all these new codes, you might be wondering what isn’t covered in the 17,000 medical codes we already use – while I’m sure any medical coder would tell you that they have a list of crucial and obvious missing codes, some of them seem a little odd to me. Though with millions of healthcare consumers out there, there really should be a code for any possible mishap! 

Here are 10 ICD-10 Codes you can look forward to.


10. W2202XA- Walked into a Lamp Post or, W2202XD- Walked into a Lamp Post- subsequent encounter (as if you did not learn from your first encounter?)


9. Z63.1 – Trouble with in-laws (this is actually a pretty valid code)


8. W16.221 – Fall into a bucket of water, causing drowning and submersion. (so you fell with your head, I assume. Or it was a very big bucket).


7. V9107XA – burns due to water skis being on fire (AKA the Evil Knievel of codes)


6. Y92241- hurt at the library (happens to me when I try to take out more books than I can feasibly carry home)


5. V9542XA – spacecraft crash injuring occupant (aliens? does this mean aliens?)


4. Y93D1 – stabbed while crocheting (but were you stabbed by the crochet hook or an intruder?)


3. Z89.419 Acquired absence of unspecified great toe (there are only two possible options)


2. W56.22xA – Struck by orca, initial encounter (as if to say this is likely to happen more than once?)


1. Z63.4 Disappearance and death of a family member (how do you know they are dead if they disappeared. . .)

C&p Results – Veteran To Veteran

Hello everyone. I was finally able to sign up for MyHealthevet and download my medical records. Here are the “highlights” of my C&P exam. If anyone has any idea of what the rating may be, please let me know. I have no idea.


Current rating = 10% for Retinitis Pigmentosa




Eye Conditions





Does the Veteran now have or has he/she ever been diagnosed with an eye

condition (other than congenital or developmental errors of refraction)?

[X] Yes [] No

If yes, provide only diagnoses that pertain to eye conditions:

Diagnosis #1: Retinitis Pigmentosa OD OS (Legally blind based on visual

Field od os)

ICD code:

Date of diagnosis: 2010




Describe the history (including onset and course) of the Veteran’s


eye condition(s) (brief summary):

1) – dxed with Retinitis Pigmentosa OU; constricted visual

field OU; hard to ambulate/function with poor lighting conditions; last eye exam

- 2013 at VA Eye Clinic.


9. Internal eye exam (fundus)



[] Normal

[x ] Abnormal

If checked, complete the following section:

a. Optic disc:

Right [X] Normal [ ] Other, describe:

Left [X] Normal [ ] Other, describe:

b. Macula:

Right [] Normal [x ] Other, describe: + post pole bone spicules OU

Left [] Normal [x ] Other, describe:

c. Vessels:

Right [] Normal [ x] Other, describe: attenuated ou

Left [] Normal [ x] Other, describe:

d. Vitreous:

Right [x ] Normal [ ] Other, describe:

Left [x ] Normal [ ] Other, describe:

e. Periphery:

Right [ ] Normal [x ] Other, describe: atbe ou


10. Visual fields


Does the Veteran have a visual field defect (or a condition that may result

in visual field defect)?

[x ] Yes [] No Retinitis Pigmentosa OU


a. Was visual field testing performed?

[ x] Yes [] No


[ x] Using Goldmann’s equivalent III/4e target

[ ] Using Goldmann’s equivalent IV/4e target (used for aphakic


b. Does the Veteran have contraction of a visual field?

[x ] Yes [] No

If yes, include Goldmann chart with this Questionnaire.


e. Does the Veteran have legal (statutory) blindness (visual field diameter

of 20 degrees or less in the better eye, even if the corrected visual

acuity is 20/20) based upon visual field loss?

[xx ] Yes [ ] No


11. Retinal conditions (XX Retinitis Pigmentosa OU – RP)


a. Indicate retinal condition, and eye affected: (check all that apply)

[x ] Retinopathy [ ] Right [ ] Left [x ] Both


1. Functional impact


Does the Veteran’s eye condition(s) impact his or her ability to work?

[x ] Yes [] No



Legally Blind based on visual field OD OS (Visual Field = < 10 degrees OD



- Will send Goldmann Visual Field OD OS to St Pete VA RO Triage (with


ICD-10 delay impacts implementation of OASIS-C1 « CMS …

In a new S&C letter, “Outcome and Assessment Information Set (OASIS)-CI / International Classification of Diseases (ICD-)9 Webinar: September 3, 2014,” (Ref: S&C: 14-40-HHA), CMS notes that is has determined that the ICD-10 delay will have an impact on the Home Health Quality Reporting Program, especially the implementation of OASIS-CI. The new version of OASIS data set items was scheduled to be implemented on October 1, 2014, but five of these codes require the use of ICD-10 codes. The letter details the codes that require change.

Additional, the S&C group will be hosting a webinar, “OASIS-C1 / ICD-9” on September 3, 2014. The webinar will cover the OASIS-C1/ICD-9 data set and its implementation, the types of changes made to the data set and changes made to the OASIS-C1/ICD-9 Guidance Manual.

OASIS-C1/ICD-9 is scheduled to be implemented on January 1, 2015.

Read the S&C letter on the CMS website.

Jul 22 : ICD-10 is only as disruptive as your EMR allows | EMR …

Most specialty providers have a general sense of the distance between where they stand today with ICD-10, and where they need to be when the ICD-10 transition officially occurs on October 1, 2015. The actual size of that gulf is largely a matter of the electronic medical record (EMR) in use. If the EMR will do all that it can (and should) to automate the transition, the ride to ICD-10 should be pleasantly smooth.

ICD-10 is a big topic because of the cash-flow disruptions that can follow inadequate preparation, but ICD-10 itself isn’t a big core activity. It doesn’t change care delivery, but rather simply replaces outdated ICD-9 code sets with newer, more expansive code sets that report performed procedures with far greater precision.

That means EMRs must accommodate the older codes on one side and the newer codes on the other side, while maintaining continuity of workflow with minimal disruption. Here are five key characteristics to look for to ensure that your EMR will power you through the ICD-10 transition smoothly:

  • Smart searching for diagnosis codes. In addition to intelligently translating ICD-9 codes to mapped ICD-10 codes, the EMR should interpret unmapped codes and show matches with the highest level of specificity, without requiring a complex search.
  • Ability to move forward at your own speed. The system should support side-by-side coding in ICD-9 and ICD-10. This enables you to generate claims with 1CD-9 up to the transition date while fostering pre-transition ICD-10 familiarization, turning it on at the time of your choosing.
  • Workflow and template preservation. The EMR should not force any changes to the way your practice works in accommodating ICD-10 and should be able to automatically place codes into existing templates.
  • Compliant with meaningful use as well as ICD-10. The EMR should be ONC-ACB certified for Meaningful Use (MU) Stage 2 to streamline MU reporting while integrating into existing workflow.
  • Coder assistance. The emphasis on automation doesn’t mean coders should remain ignorant of ICD-10. Your EMR vendor should provide assistance, such as webinars, to get coders up to speed regarding their role in the transition.

These EMR capabilities should all be in place well before October 1, 2015. As with meeting any serious deadline, advance preparation has its rewards. With ICD-10, that reward is the ability to work out the details for complete cash flow protection—and to ensure you’re not caught scrambling at the very last minute.


Healthcare Providers Lag on ICD 10 | CivSource

Earlier this year, the federal government intervened to extend the deadline for hospitals and other healthcare providers to implement a new type of medical coding called ICD-10. Typically, when patients seek treatment at a healthcare provider, those treatments are assigned billing codes so that hospitals, insurance companies, and federal programs like Medicare and Medicaid can make the appropriate payout for each part of the treatment.

US healthcare providers have been on the ICD-9 version of this coding framework since the 1970s, and lag behind the rest of the world in adopting ICD-10. Version 10 is updated to reflect new medical procedures, and new ways of providing and managing care. Healthcare providers in the US were coming up on the compliance deadline for this update, which requires significant retraining and modernization of administrative systems, and many parts of the US healthcare landscape were unsurprisingly lagging behind.

A recent survey of healthcare providers conducted by eHealth Initiative and the American Health Information Management Association (AHIMA), and sponsored by the health IT vendor Edifecs, shows that while few were on pace to meet the original deadline, half of respondents say that the delay will increase implementation costs by 11-25%. The new deadline will be October 1, 2015.

“To the extent that health plans use third-party administrators and other vendors to process health claims, the plan administrator must ensure that the vendors are ready to process claims using ICD-10 codes by the new compliance date,” says Amy Moore, Partner at Covington and Burling. This may turn out to be a tall order for healthcare providers that have shifted resources away from ICD 10 implementation now that they have more time.

Some providers, however, are continuing with implementation. Florida’s largest pediatric facility, Miami Children’s Hospital (MCH) has tapped Xerox for its ICD 10 work, and is moving forward. Xerox has created a coding and training solution that works through each phase of the change management process in addition to providing new coding technology. The offering uses simulation technology, similar to flight simulators pilots use in order to walk staff through the process.

“We’ll be ready when ICD-10 goes live,” said Ed Martinez, chief information officer at MCH.

Moore explains that it could take up to 23 months for payers to test their systems for compliance once they have implemented the updates, so the single year extension isn’t that much time, especially for providers that haven’t started.

“Providers run the risk of losing momentum if they use the extension to take the pressure off,” adds Heather Haugen, PhD and managing director of The Breakaway Group, a Xerox Company. She is working with MCH to implement the Xerox solution. “There is significant training and education required throughout all parts of a provider network. Not all ICD 10 product providers are going to do that the same way, and not all provider systems are created equal.”

ICD 10 is a key part of electronic health record implementation, as whole patient record systems need to be modernized including the billing codes. Sources at other providers say they’ve cancelled consultant contracts like Haugen’s, and are shifting resources away to other projects. As the new deadline approaches, those providers will have to start over, which is adding to implementation costs.

69% of providers in the AHIMA survey note that adding another year and pushing back implementation to 2016 would be catastrophic. Nearly the same percentage 67% say the delays aren’t improving readiness.

“I think you’ve seen some lobbying from providers who are holding back on implementation, and you’ve seen others who just don’t think it’s going to happen,” Haugen says. “It does create a segments in the healthcare system that you don’t find in other countries which operate at a national scale, and that does increase costs through to the US consumer. I think you see that realization at providers that are pushing ahead like MCH, because they’d rather not lose what they have in place. This is one part of a broader modernization effort.”

This reality is paramount for providers and US healthcare consumers. Between new health IT tools, and compliance changes like those in the Affordable Care Act, Meaningful Use guidelines, health information exchange guidelines, failure to implement isn’t really an option. Haugen expects that the educational materials like those put together by the Breakaway Group as a supplement to technology, will continue to expand, leaving providers who don’t act further and further behind.

“The technology is here, and the opportunities are here, but it’s definitely going to take providers a while to work through it. Some of that is a cultural issue, MCH understands that they have a duty to their patients and they have a sense of urgency. That view has really got to come from leadership and work its way through all corners of the organization to be successful,” Haugen said.

The Differences Between ICD-9 Codes and ICD-10 Codes | Job Enjoy

Are you a professional medical coder? Then you have an important job, because your careful coding is vital for proper diagnoses, to monitor the health of the general population, accurate reimbursement, the smooth operation of facilities that provide medical care and more. That’s why a firm understanding and comprehensive training for the ICD-10 transition will be incremental to your medical coding career.ICD-10 will replace ICD-9 on October 1, 2013 as the Unites State’s industry-wide coding system. Don’t stress. According to the AAPC, ICD-10-CM shares many similarities with ICD-9-CM, like the guidelines, conventions and rules. Anyone who is qualified to code ICD-9-CM should be able to easily make the transition to ICD-10-CM coding with the proper training. However, as a professional medical coder, there are several important differences between the two coding systems that you will need to prepare for.According to the AAPC, Major Differences Between ICD-9-CM and ICD-10-CM Include:

ICD-9-CM is mostly made up of numeric codes with three to five digits. ICD-10-CM will consist of alphanumeric codes with three to seven digits. The expanded characters of the diagnosis codes will provide more information concerning disease type, severity and anatomic site.

ICD-9-CM has about 13,600 codes and ICD-10-CM will consist of approximately 69,000 codes.

A single ICD-10-CM code can be found to not only pinpoint a particular disease, but also its current manifestation.

The current ICD-9-CM coding system does not require mapping. A two-year transition period, will allow access to both ICD-9 and ICD-10 coding systems until the transition is complete. Mapping will be required so that equivalent codes can be found for outcomes studies, medical necessity edits and more.

These major differences will impact information technology and software. The transition to ICD-10-CM will help solve certain challenges that exist with the ICD-9-CM coding system. In fact, according to the American Medical Association (AMA), a primary concern today with ICD-9 is the lack of specificity of the information conveyed in the codes. The ICD-10 coding system seeks to ratify this challenge with characters in the code that identify left or right, initial encounter versus subsequent encounter and other important clinical information. With ICD-10, codes will increase in detail, offering more information, and also, greater laterality.Another challenge with ICD-9 is that some of the chapters have reached capacity, so there is no way to add new codes. To help ratify this, new codes have been assigned to various chapters. However, this often makes it difficult for these codes to be located. Under the ICD-10 coding system, codes have increased in character length, which greatly increases the number of codes for future use and decreases the chances that chapters will run out of codes.Overall, the move from ICD-9 code sets to ICD-10 code sets will mean more details, terminology changes and expanded concepts for laterality, injuries and other related factors. According to the AMA, while the complexity of ICD-10 will provide many benefits, the complexity also enhances the need for comprehensive ICD-10 training in order to fully grasp the changes that accompany the new code sets.Early ICD-10 preparation is a smart choice. With advanced preparation, you can allow yourself adequate time to grasp all the necessary changes, as well as increase your marketability to health care facilities, doctors and more, who will need ICD-10 trained individuals to help ensure a smooth transition.Consider taking an online ICD-10 course and enjoy the flexibility of self-paced learning that allows you to keep your career on track, focus on other personal responsibilities when needed and study 24/7 – in other words, when it’s most convenient for you. Before you know it, the October 1, 2013 deadline will be here, so take charge, seek out flexible, online ICD-10 training and gain the peace-of-mind and career edge you deserve.

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