ICD-10: Are Your Reports Ready? - MidasPlus, Inc....ICD-10: Are Your Reports Ready? Barbara Craig...
Transcript of ICD-10: Are Your Reports Ready? - MidasPlus, Inc....ICD-10: Are Your Reports Ready? Barbara Craig...
ICD-10: Are Your Reports
Ready?
Barbara Craig
Midas+ SaaS Advisor
TJ McGreevy
Midas+ Solutions Advisor
11,663,990 11,663,990 11,663,999 11,663,998 11,663,997 11,663,996 11,663,995 11,663,994 11,663,993 11,663,992 11,663,991
ICD-10 Reality Check
seconds
4 months and 12 days to go
135 days
19 weeks and 2 days
3,240 hours
194,400 minutes
11,664,000
Basics: Why the move to ICD-10?
• Has been federally mandated to begin Oct. 1, 2014
• Much better specificity
• Better sensitivity regarding appropriate reimbursement
• Allows for international comparisons of diseases
• Better ability to trend issues related to public health
• Contains updated medical terminology
• Allows for the logical addition of new diagnoses and procedures
• Better measurement related to quality of care outcomes
Oct. 1, 2015
Differences between ICD-9 and ICD-10
Two different ICD-10 Code Schemes
ICD-10 CM
International Classification of Diseases,
10th Revision, Clinical Modification
ICD-10 PCS
International Classification of
Diseases, 10th Revision, Procedure Coding
System
DIAGNOSES PROCEDURES
ICD-10 CM (Clinical Modification)
Diagnoses
The ICD-10 CM – Codes are 3 to 7 characters in length
– Contains CATEGORIES, SUBCATEGORIES, and CODES
• The first three characters describe the CATEGORY, if there
are no further characters, this equals a CODE
• SUBCATEGORIES are either 4 or 5 characters
• CODES may be 3, 4, 5, 6 or 7 characters
– All CM codes start with a letter as the first character
– The second and third characters are always numeric
– There is a “.” after the third character
– An “X” is used as a placeholder
– The side of the body affected by injury or disease is included in
the diagnosis codes (laterality)
Structure of the ICD-10 CM Codes
Category
Subcategories
Decimal
Etiology,
Anatomic Site,
Severity
Extension
ICD-10 CM Category Codes (first character)
A - Communicable diseases
B - Viral diseases
C - Malignant Neoplasms
D - In situ neoplasms, diseases of the
blood
E - Endocrine, nutritional, and metabolic
diseases
F - Mental and behavioral disorders
G - Nervous system and sensory
H - Eye, ear and mastoid
I - Circulatory diseases
J - Respiratory diseases
K - Digestive diseases
L - Skin and subcutaneous tissue
M - Musculoskeletal and connective tissues
N - Genitourinary
O - Pregnancy, childbirth, and puerperium
P - Newborn
Q - Congenital malformations and chromosomal
R - Symptoms, signs and abnormal clinical finding not elsewhere classified
S - Injury, fractures
T - Burns, corrosions, poisoning toxic effects neglect, maltreatment
V - External cause of morbidity
W - External cause of morbidity
X - External cause of morbidity
Y - External cause of morbidity location
Z - Contacts, exposures
ICD-10 CM Category Codes (first 3 characters)
A00-B99 Infectious and Parasitic Diseases
C00-D49 Neoplasms
D50-D89 Diseases of Blood, Blood forming organs, immune mechanisms
E00-E89 Endocrine, nutritional, and metabolic diseases
F01-F99 Mental and behavioral disorders
G00-G99 Nervous system and sensory organs
H00-H95 Eye, ear and mastoid
I00-I99 Circulatory diseases
J00-J99 Respiratory diseases
K00-K94 Digestive diseases
L00-L99 Skin and subcutaneous tissue
ICD-10 CM Category Codes (first 3 characters)
M00-M99 Musculoskeletal and connective tissues
N00-N99 Genitourinary
O00-O9A Pregnancy, childbirth, and puerperium
P00-P96 Newborn
Q00-Q99 Congenital malformations and chromosomal abnormalities
R00-R99 Symptoms, signs abnormal clinical finding NEC
S00-T88 Injury, poisoning, and certain other external causes
V01-Y99 External cause of morbidity
Z00-Z99 Factors influencing health status and contact with
health services (e.g. preventive health, immunizations)
Examples of ICD-10 CM Codes
J11.1 Influenza, bronchial, epidemic, respiratory, upper, with pharyngitis
H16.013 Central Corneal Ulcer, bilateral
L89.012 Pressure Ulcer of right elbow, stage II
T14.90 Injury
T14.8 Injury, blood vessel NEC
S65.50 Injury, blood vessel, finger
S65.51 Injury, blood vessel, little finger laceration
S36.509 Injury, large intestine
S36.500 Injury, large intestine, ascending (right)
S36.519 Injury, large intestine, ascending (right), blast injury (primary)
V95.9 Occupant injured in powered craft accident
V95.40 Occupant injured in powered craft accident, spacecraft
V95.43 Occupant injured in powered craft accident, spacecraft collision
Which one is not a real ICD-10 Code?
T71.134 Asphyxiation due to being trapped in bed linens
T72.556 Aspiration of a fortune cookie
T75.82 Effects of Weightlessness
T82.595 Mechanical Complication of umbrella device
W16.822 Jumping into a fountain striking bottom causing
injury
ICD-10 PCS (Procedure Coding System)
Procedures
ICD-10 PCS (Procedure Coding System)
15
• PCS codes are 7 characters in length
• They DO NOT contain a decimal point
• X is used as a place holder when another
character or number does not apply.
• Z means not applicable, and is only used in the
6th and 7th Segments (Device and Qualifier)
PCS Axial Components:
16
Segment Component
1 Section
2 Body System
3 Root Operation
4 Body Part
5 Approach
6 Device Used
7 Qualifier
ICD-10 PCS Axial Components
Section Body System
Root Operation
Body Part
Approach
Device Used
Qualifier
Example 1: Total Right Hip Replacement, Metal
0 S R 9 0 1 A
Med-Surg Lower Joints
Replacement Right Hip Joint
Open Synthetic substitute,
metal
Uncemented
Example 2: Total Left Hip Replacement, Ceramic, Cemented
0 S R B 0 3 9
Med-Surg Lower Joints
Replacement Left Hip Joint
Open Synthetic substitute,
ceramic
Cemented
Example 3: Transfusion of FFP via Central Vein
3 0 2 1 3 Z 4
Administration Circulatory Transfusion Central Vein
Percutaneous
Frozen Plasma
Nonautologous
Axial Component 1 – Section (Procedures)
0 Med-Surg
1 Obstetrics
2 Placement
3 Administration
4 Measurement and monitoring
5 Extracorporeal Assistance
6 Extracorporeal Therapies
7 Osteopathic
8 Other Procedures
9 Chiropractic
B Imaging
C Nuclear Medicine
D Radiation Oncology
F Physical Rehab and
Diagnostic Audiology
G Mental Health
H Substance Abuse Treatment
Axial Component 1 – Section
Section Body
System
Root
Operation
Body
Part
Approach
Device
Used
Qualifier
Example 1: Total Right Hip Replacement, Metal
0 S R 9 0 1 A
Med-Surg Lower Joints Replacement Right Hip
Joint
Open Synthetic
substitute,
metal
Uncemented
Example 2: Total Left Hip Replacement, Ceramic, Cemented
0 S R B 0 3 9
Med-Surg Lower Joints Replacement Left Hip
Joint
Open Synthetic
substitute,
ceramic
Cemented
Example 3: Transfusion of FFP via Central Vein
3 0 2 1 3 Z 4
Administration Circulatory Transfusion Central
Vein
Percutaneous
Frozen
Plasma
Nonautologous
Volumes
Axial Component 2 – Body System 0. Central Nervous
1. Peripheral Nervous
2. Heart and Great Vessels
3. Upper Arteries
4. Lower Arteries
5. Upper Veins
6. Lower Veins
7. Lymphatic and Hemic
8. Eye
9. Ear, Nose, Sinus
B. Respiratory
C. Mouth and Throat
D. Gastrointestinal
F. Hepatobiliary and Pancreas
G. Endocrine
H. Skin and Breast
J. Subcutaneous Tissue and Fascia
K. Muscles
L. Tendons
M. Bursa and Ligaments
N. Head and Facial Bones
P. Upper Bones
Q. Lower Bones
R. Upper Joints
S. Lower Joints
T. Urinary
U. Female Reproductive
V. Male Reproductive
W. Anatomical Regions, General
X. Anatomical Regions, Upper Extremities
Y. Anatomical Regions, Lower Extremities
Axial Component 2 – Body System Section Body
System
Root Operation
Body Part
Approach
Device Used
Qualifier
Example 1: Total Right Hip Replacement, Metal
0 S R 9 0 1 A
Med-Surg Lower Joints
Replacement Right Hip Joint
Open Synthetic substitute,
metal
Uncemented
Example 2: Total Left Hip Replacement, Ceramic, Cemented
0 S R B 0 3 9
Med-Surg Lower Joints
Replacement Left Hip Joint
Open Synthetic substitute,
ceramic
Cemented
Example 3: Transfusion of FFP via Central Vein
3 0 2 1 3 Z 4
Administration Circulatory Transfusion Central Vein
Percutaneous
Frozen Plasma
Nonautologous
Axial Component 3 – Root Operation (This example goes only with Med-Surg from Segment 1)
0. Alteration
1. Bypass
2. Change
3. Control
4. Creation
5. Destruction
6. Detachment
7. Dilation
8. Division
9. Drainage
B. Excision
C. Extirpation
D. Extraction
F. Fragmentation
G. Fusion
H. Insertion
J. Inspection
K. Map
L. Occlusion
M. Reattachment
N. Release
P. Removal
Q. Repair
R. Replacement
S. Reposition
T. Resection
V. Restriction
W. Revision
U. Supplement
X. Transfer
Y. Transplantation
Axial Component 3 – Root
Operation Section Body System
Root Operation
Body Part
Approach
Device Used
Qualifier
Example 1: Total Right Hip Replacement, Metal
0 S R 9 0 1 A
Med-Surg Lower Joints
Replacement Right Hip Joint
Open Synthetic substitute,
metal
Uncemented
Example 2: Total Left Hip Replacement, Ceramic, Cemented
0 S R B 0 3 9
Med-Surg Lower Joints
Replacement Left Hip Joint
Open Synthetic substitute,
ceramic
Cemented
Example 3: Transfusion of FFP via Central Vein
3 0 2 1 3 Z 4
Administration Circulatory Transfusion Central Vein
Percutaneous
Frozen Plasma
Nonautologous
Axial Component 4 – Body Part This varies with each Body System chosen
Axial Component 2- Body System
Axial Component 4- Body Part
1 G L
2-Cardiac Coronary Artery, 2 Sites
Mitral Valve Ventricle, Left
W-Anatomic Region Thumb, Right
Lower Back
B-Respiratory Trachea Upper Lung Lobe, Left
Lung, Left
Axial Component 4 – Body Part This varies with each Body System chosen
Section Body System
Root Operation
Body Part
Approach
Device Used
Qualifier
Example 1: Total Right Hip Replacement, Metal
0 S R 9 0 1 A
Med-Surg Lower Joints
Replacement Right Hip Joint
Open Synthetic substitute,
metal
Uncemented
Example 2: Total Left Hip Replacement, Ceramic, Cemented
0 S R B 0 3 9
Med-Surg Lower Joints
Replacement Left Hip Joint
Open Synthetic substitute,
ceramic
Cemented
Example 3: Transfusion of FFP via Central Vein
3 0 2 1 3 Z 4
Administration Circulatory Transfusion Central Vein
Percutaneous
Frozen Plasma
Nonautologous
Axial Component 5 - Approach
Approach
0 Open
3 Percutaneous
4 Percutaneous endoscopic
7 Via natural or artificial opening
8 Via natural or artificial opening endoscopic
X Closed/External
Axial Component 5 - Approach Section Body
System
Root Operation
Body Part
Approach
Device Used
Qualifier
Example 1: Total Right Hip Replacement, Metal
0 S R 9 0 1 A
Med-Surg Lower Joints
Replacement Right Hip Joint
Open Synthetic substitute,
metal
Uncemented
Example 2: Total Left Hip Replacement, Ceramic, Cemented
0 S R B 0 3 9
Med-Surg Lower Joints
Replacement Left Hip Joint
Open Synthetic substitute,
ceramic
Cemented
Example 3: Transfusion of FFP via Central Vein
3 0 2 1 3 Z 4
Administration Circulatory Transfusion Central Vein
Percutaneous
Frozen Plasma
Nonautologous
Axial Component 6 – Device Used (depends on System and Body Part)
Example 1- Total Hip Replacement Example 3- FFP Transfusion
Med-Surg Lower Joints Administration - Circulatory
1 Synthetic Substitute, Metal A Stem Cells, Embryonic
2 Synthetic Substitute, Metal on Polyethylene G Bone Marrow
3 Synthetic Substitute, Ceramic H Whole Blood
4 Synthetics Substitute, Ceramic on Polyethylene K Frozen Plasma
7 Autologous Tissue Substitute N Red Blood Cells
J Synthetic Substitute Q White Cells
K Nonautologous Tissue Substitute R Platelets
T Fibrinogen
V Antihemophilic Factors
W Factor IX
Axial Component 7 – Qualifier Section Body
System
Root Operation
Body Part
Approach
Device Used
Qualifier
Example 1: Total Right Hip Replacement, Metal
0 S R 9 0 1 A
Med-Surg Lower Joints
Replacement Right Hip Joint
Open Synthetic substitute
metal
Uncemented
Example 2: Total Left Hip Replacement, Ceramic, Cemented
0 S R B 0 3 9
Med-Surg Lower Joints
Replacement Left Hip Joint
Open Synthetic substituteceramic
Cemented
Example 3: Transfusion of FFP via Central Vein
3 0 2 1 3 Z 4
Administration
Circulatory
Transfusion Central Vein
Percutaneous
Frozen Plasma
Nonautologous
Which is not a real ICD-10 CM Code?
W55.22 Struck by a cow
W56.21 Bitten by an orca
W61.33 Pecked by a chicken
W61.39 Sprayed by a skunk
W61.62 Struck by a duck
Of course, “W61.39 - Sprayed by a skunk” is not an actual ICD-10 code…
But “W56.21 - Bitten by an orca” is an actual code. Go figure.
Midas+ and ICD-10 Transition Strategy
ICD-10 codes can be loaded into the existing Diagnosis and Procedure Dictionaries. (#43 and #44)
This allows seamless historical reporting and longitudinal data integrity
No application version upgrade is required to accommodate ICD-10 codes in our products.
A software modification to existing versions is needed to properly process interface transactions containing ICD-10 codes.
This no-cost overlay package can be delivered to versions 7.2 and higher.
Midas+ and ICD-10 Transition Strategy
Midas+ CPMS and DataVision enhancements that incorporate ICD-10 codes:
• Modifications to national measure sets based on requirements (Core Measures, AHRQ)
• Add ICD-10 codes to existing applicable pre-defined indicators to reflect analogous populations
• Retirement of metrics for which it is impossible to accurately reflect the same population using ICD-10
• Creation of new metrics reflecting the higher level of specificity made possible by the use of ICD-10
Changes in Midas+ Version 2011 to Accommodate ICD-10s
Standard Reports Modified
The following reports have been modified to accommodate selection criteria for ICD-10 codes:
ENC PROCEDURE SUMMARY
• ICD-9 PROCEDURE SUMMARY report has been renamed ENC PROCEDURE SUMMARY
• The From ICD-9 code: field in the report has been relabeled ICD-9/CPT Code From:
• The To ICD-9 code: field now simply reads To:
• An added field labeled ICD Code Is Like: allows pattern-matching search capability
The following two reports have also been updated to use Is Like for ICD-10:
• QM ADM/ATT PHYS PROFILE
• QM DISEASE PROFILE
The content of the generated reports has not changed, with the exception of renaming “ICD-9” column headers to “ICD.”
SmarTrack Changes in Version 2011 to Accommodate ICD-10s
SmarTrack Variables Added to Support ICD-10 Dx and Px Codes:
• ENCOUNTER:DIAGNOSES:Diagnosis:Category
• ENCOUNTER:DIAGNOSES:Diagnosis:Code Is Like
• ENCOUNTER:Principal Diagnosis:Code Is Like
• ENCOUNTER:PROCEDURE:Procedure:Section/Body System
• ENCOUNTER:PROCEDURES:Procedure:Code Is Like
• ENCOUNTER:Principal Procedure:Code Is Like
These variables can be used in any rule or indicator that identifies
encounters. The pattern search capability applies to codes only, not to
descriptions.
Building SmarTrack Rules If you know the exact code you are building a rule on, you can continue to use existing fields: Encounter:Diagnosis:Diagnosis Encounter:Principal Diagnosis Encounter:Procedures:Procedure Encounter:Principal Procedure and All corresponding Previous or Next Diagnosis or Procedure fields
Exact Code entered = V98.3XXS
Building Rules on ICD-10 Diagnoses
ENCOUNTER:DIAGNOSES:Diagnosis:Category
ENCOUNTER:DIAGNOSES:Diagnosis:Code Is Like
ENCOUNTER:Principal Diagnosis:Code Is Like
ICD-10 CM Category Codes (first 3 characters)
Infectious & Parasitic A00-B99
Neoplasms C00-D49
Blood, Blood forming organs, immune mechanisms D50-D89
Endocrine, nutritional, & metabolic E00-E89
Mental & behavioral disorders F01-F99
Nervous system & sensory organs G00-G99
Eye, ear and mastoid H00-H95
Circulatory diseases I00-I99
Respiratory diseases J00-J99
Digestive diseases K00-K94
Skin and subcutaneous tissue L00-L99
Musculoskeletal and connective tissues M00-M99
Genitourinary N00-N99
Pregnancy, childbirth, and puerperium O00-O9A
Newborn P00-P96
Congenital malformations and chromosomal abnormalities Q00-Q99
Symptoms, signs abnormal clinical finding NEC R00-R99
Injury, poisoning, and certain other external causes S00-T88
External cause of morbidity V01-Y99
Factors influencing health status and contact with health services Z00-Z99
J09 Influenza due to certain identified influenza viruses
J10 Influenza due to other identified influenza virus
J11 Influenza due to unidentified influenza virus
J12 Viral pneumonia, not elsewhere classified
J13 Pneumonia due to Streptococcus pneumoniae
J14 Pneumonia due to Hemophilus influenzae
J15 Bacterial pneumonia, not elsewhere classified
J16 Pneumonia due to other infectious organisms, not elsewhere clsfd
J17 Pneumonia in diseases classified elsewhere
J18 Pneumonia, unspecified organism
J20 Acute bronchitis
J21 Acute bronchiolitis
J22 Unspecified acute lower respiratory infection
J30 Vasomotor and allergic rhinitis
ICD-10 CM Categories: J09 – J30
1908 Total CM (Diagnosis) Categories
B26 Mumps
B26.0 Mumps orchitis
B26.1 Mumps meningitis
B26.2 Mumps encephalitis
B26.3 Mumps pancreatitis
B26.8 Mumps with other complications
B26.81 Mumps hepatitis
B26.82 Mumps myocarditis
B26.83 Mumps nephritis
B26.84 Mumps polyneuropathy
B26.85 Mumps arthritis
B26.89 Other mumps complications
B26.9 Mumps without complication
ICD-10 CM Category: B26
G90 Disorders of autonomic nervous system
G90.0 Idiopathic peripheral autonomic neuropathy
G90.01 Carotid sinus syncope
G90.09 Other idiopathic peripheral autonomic neuropathy
G90.1 Familial dysautonomia [Riley-Day]
G90.2 Horner's syndrome (Bernard-Horner) syndrome
G90.3 Multi-system degeneration of the autonomic nervous system
G90.4 Autonomic dysreflexia
G90.5 Complex regional pain syndrome I (CRPS I) / Reflex sympathetic dystrophy
G90.51 Complex regional pain syndrome I of upper limb
G90.511 Complex regional pain syndrome I of right upper limb
G90.512 Complex regional pain syndrome I of left upper limb
G90.513 Complex regional pain syndrome I of upper limb, bilateral
G90.519 Complex regional pain syndrome I of unspecified upper limb
G90.52 Complex regional pain syndrome I of lower limb
G90.521 Complex regional pain syndrome I of right lower limb
G90.522 Complex regional pain syndrome I of left lower limb
G90.523 Complex regional pain syndrome I of lower limb, bilateral
G90.529 Complex regional pain syndrome I of unspecified lower limb
G90.59 Complex regional pain syndrome I of other specified site
G90.8 Other disorders of autonomic nervous system
G90.9 Disorder of the autonomic nervous system, unspecified
ICD-10 CM Category: G90
Encounter:Diagnosis:Diagnosis:Category
Searching Diagnoses and Procedures in SmarTrack
You can search by Code or Description, use Begins With, Is Like, and Contains, AND sort your dictionary by either the Code or Description.
Searching with Wildcards
Use the wildcards % and _ (underscore) to search
for diagnosis codes with certain patterns.
% is used in a string to indicate inclusion of any
characters that follow.
_ (underscore) is used as a placeholder to capture
any character in that position.
ENCOUNTER:DIAGNOSES:Diagnosis:Code Is Like
For example: O64 = Obstructed Labor
• To capture all obstructed labors due to breech presentation of the fetus, enter O64.1% as a condition variable.
ENCOUNTER:DIAGNOSES:Diagnosis:Code Is Like
Wildcard _ (underscore)
Use ‘underscore’ to capture all characters in a specified position. Because of the structure of ICD-10’s, there must be an exact match in the other positions in the code.
To capture all closed fractures of the left humerus:
All of the diagnoses indicated represent an “initial encounter for a closed fracture of the left humerus.” Those codes all start with S42.2 and end with A.
To ignore the two characters between the second 2 and the A, use two underscores, and search for S42.2_ _A
Diagnosis:Code Is Like
ENCOUNTER:Diagnosis:Diagnosis:Code Is Like
ENCOUNTER:Principal Diagnosis:Code Is Like
The same logic applies when building rules for:
Building Rules on ICD-10 Procedures
ENCOUNTER:PROCEDURE:Procedure:Section/Body System
ENCOUNTER:PROCEDURES:Procedure:Code Is Like
ENCOUNTER:Principal Procedure:Code Is Like
ENCOUNTER:Principal Procedure:Section/Body System
When building rules on Procedures, this new condition evaluates the first two segments in the PCS Codes.
ENCOUNTER:PROCEDURE:Procedure:Section/Body System
ENCOUNTER:Principal Procedure:Section/Body System
In this case 02 was entered
(there are 2148 procedure codes that start with 02)
ENCOUNTER:PROCEDURES:Procedure:Code Is Like
ENCOUNTER:Principal Procedure:Code Is Like Section Body
System Root
Operation Body Part Approach Device Used Qualifier
0 Med/Surg 2 Cardiac
1 Bypass 1 Coronary Artery, Two sites
0 Open 9 Autologous Venous Tissue
1 Coronary Artery
0 Med/Surg 2 Cardiac 1 Bypass 2 Coronary Artery, Three sites
0 Open Z No Device C Thoracic Artery
0 Med/Surg 2 Cardiac 7 Dilation
1 Coronary Artery, Two sites
3 Percutaneous D Intraluminal 6 Bifurcation
0 Med/Surg 2 Cardiac 1 Bypass K Ventricle, right
0 Open Z No Device
F Abdominal Artery
0 Med/Surg 2 Cardiac Q Repair
K Ventricle, right
3 Percutaneous Z No Device
Z No Qualifier
Procedures “Section:Body System” (samples) 0T Medical and Surgical:Urinary System
0U Medical and Surgical:Female Reproductive System
0V Medical and Surgical:Male Reproductive System
0W Medical and Surgical:Anatomical Regions, General
0X Medical and Surgical:Anatomical Regions, Upper Extremities
0Y Medical and Surgical:Anatomical Regions, Lower Extremities
2W Placement:Anatomical Regions
2Y Placement:Anatomical Orifices
3C Administration:Indwelling Device
3E Administration:Physiological Systems and Anatomical Regions
4A Measurement and Monitoring:Physiological Systems
4B Measurement and Monitoring:Physiological Devices
5A Extracorporeal Assistance and Performance:Physiological Systems
6A Extracorporeal Therapies:Physiological Systems
7W Osteopathic:Anatomical Regions
8C Other Procedures:Indwelling Device
8E Other Procedures:Physiological Systems and Anatomical Regions
9W Chiropractic:Anatomical Regions
102 Total Section/Body System Combinations
ENCOUNTER:PROCEDURES:Procedure:Code Is Like
ENCOUNTER:Principal Procedure:Code Is Like
027_3D%
027_3D%
Search Dictionary Using the “Is Like” Criteria
Search Dictionary Using the “Is Like” Criteria
Reporting ICD-10s in ReporTrack
The NEW Midas+ Conversion Utility
To optimize reporting on new ICD-10 codes, all Indicators and ReporTrack reports using current ICD-9 dictionaries must be reviewed and modified to include the equivalent ICD-10 terms.
This process may take a lot of time and resources to complete, so Midas+ has developed a potentially significant interim solution for Care Management.
What is GEMS? The ICD-10 General Equivalency Mapping tools is a
bidirectional “crosswalk” between ICD-9 and ICD-10
has been developed by: – National Center for Health Statistics (NCHS)
– Centers for Medicare and Medicaid (CMS)
– American Health Information Management Association (AHIMA)
– American Hospital Association (AHA)
– 3M Health Information Systems
GEMS Conversion Table
The current GEMS table is imbedded in the
Midas+ conversion process to allow you to view
ICD-9 codes in reports and add the appropriate
ICD-10s.
Midas+ offers two separate conversion utilities
as a package (at no charge);
one for SmarTrack, and one for ReporTrack.
Midas+ Conversion Utility
The Midas+ Care Management ICD-10 Conversion Utility
reviews the conditions of every SmarTrack Indicator and
Rule for the presence of conditions pointing to the Diagnoses
and Procedures tables.
This utility reviews the qualifying ICD-9 terms and creates an
equivalent set of qualifying ICD-10 terms which are then
added to the Rule conditions. Once converted, these Rules
would then be able to display qualifying records with ICD-9
and/or ICD-10 data at the same time.
Conversion of Indicators and Reports
The conversion of reports to include ICD-10s is a
three step process:
1. Midas+ will run an analyzer to review your existing
reports, and provide you with a report on what would be
included if the utility was actually deployed. You would
then have an idea of what you might need to modify to
meet your needs.
NOTE: Diagnoses and Procedures dictionaries must contain the most current ICD-9 and ICD-10 terms before beginning the conversion!
Conversion of Indicators and Reports
2. After your review, you can request a test conversion in
your Midas+ test area. You can then “practice”
modifying key converted items to meet your intentions
and review the results.
Conversion of Indicators and Reports
3. Finally, the actual conversion of your reports and
indicators is run in your Midas+ production area. You
must then make the appropriate modifications to your
reports to have them function as intended.
Remember that there will not be actual data in these reports that reflect ICD-10 data until 10/1/2015!
Conversion of Indicators and Reports
Remember W56.21 “Bitten by an Orca”?
What was that in ICD-9?
• ICD-10-CM W56.21XA “Bitten by orca, initial encounter” converts approximately to: ICD-9-CM E906.3 Bite of other animal except arthropod (not bitten by a beetle, scorpion, panda bear, etc.)
What if you already have E906.3 in a patient’s record as an ICD-9? What will it convert to in ICD-10?
• ICD-9-CM E906.3 converts approximately to: ICD-10-CM W55.01XA
Bitten by cat, initial encounter
Where are you with ICD-10?
Fewer than 10% of Midas+ facilities have
done any kind of ICD-10 conversion testing.
Contact your Account Manager ASAP to get
started!
Documents on the Clients Only Website:
• How to Search ICD-10s in SmarTrack or ReporTrack
• ICD10 Conversion Utility
Which one is not a real ICD-10 Code? V00.151 Fall from heelies
V50.2 Person outside of a pick-up truck injured in a collision with an animal
W17.82 Fall out of a grocery cart
W21.04 Struck by a golf ball
W45.1 Paper cut
W54.32 Lacerations from handcuffs
X98.1 Assault by hot tap water
“W17.82 - Fall out of a grocery cart” is an actual code!
Thanks for attending.
Are there any questions?
Barbara Craig, SaaS Advisor
TJ McGreevy, Solutions Advisor