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

Barbara.Craig@xerox.com

TJ McGreevy, Solutions Advisor

TJ.McGreevy@xerox.com