Health Information Management

ICD-10 misinformation campaign continues in university study

APCs Insider, May 29, 2015

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By Steven Andrews
While the AMA has focused on scaremongering instead of educating physicians ahead of the rapidly approaching ICD-10 deadline, it hasn’t cornered the market on misrepresenting facts to make the transition appear more costly, confusing, and challenging.
ICD-10 is poised to cause massive problems specifically for emergency medicine, according to a study published in the May issue of the American Journal of Emergency Medicine.
Researchers "found that when they looked at more than 24,000 actual clinical encounters in the ER, 23% could be assigned incorrect codes if recommendations of the Center for Medicare and Medicaid Services were followed," according to a press release.
This sounds troubling, until one looks at the actual study and the methodology it used. The entire study is based on the complex mappings between ICD-9-CM and ICD-10-CM by using the General Equivalence Mapping (GEM) files supplied by CMS. 
The GEMs allow providers to input an ICD-9-CM code and get a mapping to potentially similar ICD-10-CM codes and vice versa. While some one-to-one matches do exist, in many cases there are no truly equivalent mappings. This makes sense, because if they did, there'd be no advantage to moving to the new, much more specific code set.
For example, the study notes that ICD-9-CM code 813.42 (other closed fractures of distal end of radius [alone]) could map to 44 potential ICD-10-CM codes. "Challenges in identifying correct sets of codes to generate accurate documentation will require additional time, training, and, potentially, emergency physicians participation in the process," the study says.
This is all undoubtedly true. ICD-10-CM will require the physicians to rigorously document such additional information as whether the fracture occurred on the right or left leg to avoid an unspecified code. For an initial encounter, that's the only additional information that providers need to worry about. I know EDs are often hectic environments, but I doubt this will require too much extra time, training, or provider participation to implement.
Another thing to consider: coders can use additional details from the radiology report to report diagnoses. ICD-10 details that create so many additional mappings from ICD-9-CM such as the site and type of fracture can be taken from other sources and aren't entirely reliant on ED physicians.
The study seems to completely misunderstand the point of GEMs. CMS has clearly stated GEMs are to be used to give providers an idea of what types of codes to use, not as a direct coding tool. The GEMs are no replacement for natively coding in ICD-10 according to CMS' recommendations, as the study states.
In its conclusion, the study notes that the ICD-9-CM to ICD-10 transition "is not straightforward and contains hidden mapping and planning challenges that may have not been accounted for even at this late stage of the sprint toward ICD-10-CM implementation."
It's pretty unbelievable that providers could be surprised by anything in the mappings, which have been available for years, at this stage of ICD-10 preparations. To avoid all the challenges associated with GEMs, coders need to be trained on ICD-10 and providers need to learn what additional information they need to document. This would completely avoid the disaster the study portends.
HCPro is presenting weekly ICD-10 refresher webcasts all summer in order to prepare coders and providers for the upcoming transition. The webcasts will cover a variety of topics and specialties, including information on anatomy, documentation, and tricky coding conventions. For more information, visit

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