ICD 10 – Crosswalk (Bridge between ICD-9 and ICD-10) Strategies

ICD-10 codes are ten times as granular as their predecessors

. This opens up whole new opportunities to improve patient safety, care delivery and streamline provider reimbursements but all that is possible, if and only if I-10 codes are captured at the point of service (or the provider's billing department). If the provider continues to capture I-9 codes and that's what is going to be sent to the payer, then there's a subtle chance that the benefits will be fully realized. But nonetheless that's going to be the situation. Based on the market feedback, most providers will continue to capture, store and send I-9 codes for a long period post the compliance date. The transition period will be long, may be very long.

So, there's going to be interoperability challenges for many years. Payers will expect I-10 codes, but providers will send I-9. Had it been the other way round, things would have been less complex, but still not simple. Converting an I-9 code to I-10 on the other hand is a very complex issue and a crosswalk will be required.

The major shortcoming of an I-9 to I-10 crosswalk will be its effectiveness. As with any one-to-many mapping you'll need additional data to be able to make an accurate judgment. Now this additional data might be there in the PWK (paperwork) segment but it's still unreliable to the extent that it's optional in 5010 transactions.

Then, deciphering the PWK segment and make enough sense out of the physician's notes to be able to zero in on the ICD-10 code is a complex issue. One could also look at the entire claim to determine the I-10 code that matches the scenario. But the rules will be complex and will need to be constantly reviewed for accuracy.

With any luck, effectiveness of the I9-I10 crosswalk will be in the 80% range. So that would mean 20% of the cases will need to be manually evaluated to determine the I-10 code. Assuming that 50% of the providers will continue to be on I-9 codes, that's about 10% drop in automation. This will translate to significant backlogging and delay in claim payments.

Add to that, the doubts around accuracy. Firstly, there will need to be manual intervention to verify the accuracy of the crosswalk and secondly, manual intervention to process the old and current records that were inaccurately mapped. This will be significant cost overhead on the payer side.

All in all, payers will end up bearing the cost for providers not capturing the I-10 code. Providers will lose on cash-flow because of the delays in reimbursements. This is an ecosystem level problem. To reduce the transition period, payers and providers will need to move in the same direction, hand in hand and at almost the same pace. Otherwise, the industry will need to be prepared to deal with significant drop in automation, and delays and overhead costs.

ICD 10 Crosswalk (Bridge between ICD-9 and ICD-10) Strategies

By: gssmktng

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