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Extreme Makeover - ICD-10 Code Edition:
Demystifying the Conversion Toolkit
Deborah Kohn, MPH, RHIA, FACHE, CPHIMS, FHIMSS
Principal - Dak Systems Consulting, San Mateo CA
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest Disclosure
Deborah Kohn
has no real or apparent
conflicts of interest to report.

© 2012 HIMSS

Learning Objectives
By attending this session, attendees will be able to:
 describe the differences between the plethora of
available tools to assist in the ICD-10
implementation and conversion processes
 define the various types of vendor-provided and
government-provided ICD-10 conversion tools
 develop a legacy database "purpose-built map" for
ICD-10 conversion, if required
 determine the requirements for acquiring and
using computer-assisted coding (CAC) software

Welcome to the Plethora
of ICD-10 Conversion Tools!
 Translation engine tools
 Code mapping tools
 Crosswalks
 GEMs
 Code simulation tools
 Medical language / content management tools
 Computer-assisted coding software
 and more …
What's a healthcare organization to use?

ICD-10 Tools To Consider
Before and/or After Conversion
 Translation / Mapping Engines
 Code Mapping Tools
 Reference Maps
 Purpose-built Maps
 Code Simulation Tools
 Medical Language / Terminology /
Content Management Tools
 Computer-assisted Coding (CAC)
 Business Analytics / Modeling

Translation / Mapping Engines
Tools that provide all plausible translation
alternatives or one “best” translation
alternative for each code in the target
system based on the complete meaning
of the code in the source system

Code Mapping Tools
 The designation of all plausible code
alternatives or one best code alternative
depends on:
 the use to which the map will be put
(REFERENCE or PURPOSE-BUILT)
 the external data, such as volumes or prices,
that are particular to the application that will use
the map
 are NOT substitutes for learning how to use
ICD-10 CM/PCS or for coding medical records

Code Mapping Tools
REFERENCE MAPS
 are tools to assist users with the conversion of
large ICD-9 CM (or SNOMED or other) databases
to ICD-10 CM / PCS
“find” and “replace” codes or lists of codes in large databases

 help users navigate the complexity of translating
meanings from large ICD-9 (or SNOMED or other)
databases to ICD-10
 present all plausible code translation alternatives

Code Mapping Tools
REFERENCE MAPS
e.g., GEMS
The General Equivalence Mappings (GEMs) is
the public domain REFERENCE MAP product
developed over several years by a coordinated
effort between the Centers for Medicare &
Medicaid Services (CMS), Centers for Disease
Control & Prevention (CDC), the National Center
for Health Statistics (NCHS), an encoder vendor,
and other organizations.

Code Mapping Tools
REFERENCE MAPS
e.g., GEMS
ICD-9-CM ICD-10-CM
ICD-9-CM ICD-10-PCS
 CMS tested the effectiveness of the GEMs by
converting v26.0 of the MS-DRGs (one of CMS’
more complex payment systems) to a native
ICD-10-based application
 added to the CMS website
 will be refined as needed!

GEMs are used to:
 convert and test (i.e., normalize the data in)
large database systems, such as ICD-9 CM
databases to ICD-10 CM / PCS databases
 link trending data in long-term clinical /
research studies
 analyze data collected during the conversion
period and beyond
 track quality measures
 record morbidity & mortality

GEMs are NOT substitutes
for learning how to use
ICD-10 CM/PCS
and / or
for coding medical records.

GEMs vs. Crosswalks
 There is NO straightforward, one-to-one
“crosswalk” (i.e., one-to-one match ) between
all the ICD-9 and ICD-10 codes.
 One-to-one (but values might be different)
 One-to-many (each of which is a possible translation)
 Clusters (one-to-multiple codes, all of which are
required to be complete)
 No match (there is no equivalent meaning from one
code set to the other)

GEMs vs. Crosswalks
 The 2010 Patient Protection and Affordable
Care Act (ACA - Healthcare Reform) required
that
the Secretary of Health and Human Services (HHS),
in consultation with stakeholders, shall post on the
CMS website a “crosswalk” between the previous
and subsequent versions of ICD

any revised “crosswalk” be treated as a HIPAA
code set standard adopted by the Secretary

GEMs vs. Crosswalks
 On September 15, 2010, the ICD-9 CM
Coordination & Maintenance Committee:
 clarified that the “crosswalks” mentioned in
the ACA refer to the GEMs posted on the CMS
website
 legislated that the GEMs posted on the CMS
website are the nation’s HIPAA code set
standard map between ICD-9 CM and ICD-10
CM/PCS

Code Mapping Tools
PURPOSE-BUILT MAPS
 maps in which decisions have been made to
identify the closest matching code from all
possible codes (e.g., the one best alternative)
 typically are backward maps – mapping from
multiple ICD-10 CM/PCS codes back to ICD-9 CM
codes
 can use the GEM REFERENCE MAPS as
starting points to develop PURPOSE-BUILT
MAPS

Code Mapping Tools
PURPOSE-BUILT MAPS
e.g.,
REIMBURSEMENT MAPS
OUTPATIENT-FOCUSED MAPS
PUBLIC HEALTH-FOCUSED MAPS
RESEARCH-FOCUSED MAPS
OTHER MAPS

Code Mapping Tools
PURPOSE-BUILT MAPS
e.g., REIMBURSEMENT MAPS
 CMS developed backward ICD-10 REIMBURSEMENT MAPS
for Medicare inpatient reimbursement from the GEM
REFERENCE MAPS …
in response to other payers’ requests
 potential tool for payers, not providers
to help other payers prepare for the conversion and support
the phase-out of ICD-9 after the conversion.
 temporary mechanism for backward mapping records
containing ICD-10 codes to “reimbursement-equivalent”
ICD-9 codes.

Code Mapping Tools
PURPOSE-BUILT MAPS
e.g., REIMBURSEMENT MAPS
 are posted to the CMS website
 CMS has stated:
 that it does not plan to use the Reimbursement
Maps for any purpose
 that they were created to demonstrate the
GEMs could be used to develop a “crosswalk”

Code Mapping Tools
REFERENCE MAPS
PURPOSE-BUILT MAPS
-Observations-

 Important for renegotiating payer contracts
 Expect to see more Purpose-Built Maps after
the ICD-10 Conversion.

Code Simulation Tools
 are substitutes for learning how to use ICD-10
CM / PCS or for coding medical records

 typically developed by the encoder vendors

 typically include a toggle between the two
classification systems

 can be used before and after conversion

Code Simulation Tools
-Observations-
 Watch for current versions!
 On September 15, 2010, the ICD-9 CM
Coordination & Maintenance Committee
partially froze both the ICD-9 CM and ICD-
10 CM / PCS code sets.
 On September 14, 2011, the ICD-9 CM
Coordination & Maintenance Committee
released the 2012 release of ICD-10-CM.

Medical Language / Terminology /
 attempt to standardize terminology using dozens
of international code sets (SNOMED-CT, LOINC,
RxNorm, ICD-10, CPT, etc.)
 e.g., SNOMED or ICD-10 for problem lists to meet Meaningful Use
requirements?
 able to codify the clinical content of a health
record at the point-of-care
 typically are embedded in other tools
 e.g., Code Mapping Tools, Code Simulation Tools, and Healthcare
Information Systems

Medical Language / Terminology /
-Observations-
 Consider acquiring!
 Helps to create a single source of Language
or Terminology truth (via a server) for the
enterprise!
 e.g., Is it ALS or Lou Gehrig’s Disease?

 Translation / Mapping Engines
 Code Mapping Tools
 Reference Maps
 Purpose-built Maps
 Code Simulation Tools
 Medical Language / Terminology /

Computer-Assisted Coding
(CAC)

 Automatically generate codes
 CAC uses
either
 natural language processing (NLP) /
natural language understanding (NLU)
or
 structured data input
or both

 NLP / NLU helps boost a coding
professional’s productivity by using
artificial intelligence to identify concepts in
free text and to associate codes from
controlled vocabularies to the relevant
phrases in the text.


 NLP / NLU Engines
 Symbolic Rules-based
 Statistical-based
 Pattern Matching-based
 Blended
 …..

 Using NLP / NLU in CAC systems
 Steps in the workflow can prevent coders
from receiving the health record until key
documents are available.
 Coding professionals still need to review
the codes generated by the CAC to ensure
accuracy and proper reimbursement.

 Structured data input is driven by
healthcare providers documenting care in
electronic health / medical records.

 Using structured data in CAC systems
 HIM professionals’ expertise is required
regarding health record content
management.
 Coding professionals still need to review the
codes generated by CAC to ensure accuracy
and proper reimbursement.

 Additional features can include:
 Improving concurrent coding
 Improving remote coding
 Integrating coding workflow
 Reimbursement analysis
 Enhanced business intelligence

 MUST be INTEGRATED with your:
 Encoder System
 Clinical Documentation Improvement (CDI)
System (with Clinician Queries)
 This system guides the clinician through the
documentation process, automatically
capturing the clinician documentation.
 Voice / Text / Speech System
 Coding Workflow Application
 If you don’t have this app in your abstracting
system, either get it or determine if it is
included in CAC system!

Many vendors have or are developing CAC tools!
 CAVEATS!
 Currently, all are built for ICD-9 use
 To date, some CAC products have been installed
ONLY IN
 inpatient environments
OR
 outpatient (ambulatory care) environments
OR
 ancillary departments (e.g., radiology, cardiology)

-Observations-
 With CAC’s emphasis that the data must be
in an electronic format (structured), the
ARRA/HITECH incentive payments not
only will drive adoption of the meaningful
use of certified EHRs, but also it will drive
adoption of CACs.

-Observations-
 With the overwhelming increase in the
quantity of ICD-10 codes, enhancing the
productivity of coders with CAC will
become critical.

Before Conversion
Business Analytics / Modeling

Many vendors have or are developing tools that:
 help users create a map to migrate/convert historical
ICD-9 data to ICD-10 for modeling and predicting

 identify areas were ICD-9 codes are utilized within
current business applications and will need to be
converted to ICD-10

 can be used for many types of analytic purposes

 test software changes (and include test scripts)

How Many Coders Will You Need? Source: ELIPSe, Inc., 2011

Projected Need for Coders
2013-2014
40.0

35.0
33.8

30.0
28.8
Number of coders

24.2
25.0
19.7
20.0 17.9 17.7
16.1 Current Coders
15.0 12.7 Add'l Coders Needed

10.0 8.1

5.0
3.6
1.8
0
0.0
Current 10% 20% 30% 40% 50%
Decreased Productivity

ICD-10 Implementation Cost Prediction
Modeling Tool
COST IMPACT AND TIMING OF THE ICD-10 CONVERSION BY CATEGORY
Source: HIMSS 2011 ICD-10 Task Force
Year: 2011 2012 2013 (to 3Q) 2013 (3Q) - 201 2014 (??-) 2015
Status: Preparation Preparation Preparation Transition Permanent Permanent
Cost Category
Coding
Compensation Low High Med
Training Low High Med Med Low
Productivity Low High Med Med
Recruiting Low Med High Med Med
Accuracy High Med Low

Revenue
Training Low Low Med
Productivity High Med Low
Accuracy High Med Low
Renegotiate contracts Med High High Med
Revenue /Claim Med Low
Denial Rate High Med Med

IT Med Med High Med Low Low

PM Low Med High Med Low Low

ICD-10 Implementation Cost Prediction
Modeling Tool
PROJECTED IMPACT OF THE ICD-10 CONVERSION ON YOUR ORGANIZATION
Source: HIMSS 2011 ICD-10 Task Force

Sources of cost 2012 2013 2014 2015 2016 TOTAL
Coding $ 630,000 $ 732,500 $ 562,250 $ 362,250 $ 362,250 $ 2,649,250
Revenue Cycle $ 2,500 $ 14,500 $ 3,744,800 $ 2,166,438 $ 1,000,000 $ 6,928,238
Project Management $ 1,000,000 $ 1,000,000 $ - $ - $ - $ 2,000,000
IT $ - $ 21,375,000 $ - $ - $ - $ 21,375,000
Total ICD-10 Transition $ 1,632,500 $ 23,122,000 $ 4,307,050 $ 2,528,688 $ 1,362,250 $ 32,952,488

-Observations-
 Why not utilize?
 Data analytics are practical!

Questions?????
For further information, please contact:

Deborah Kohn
dkohn@daksystcons.com
http://www.daksystemsconsulting.com

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HIMSS 2012

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