With the rebooting of ICD-10 programs subsequent to the recent U.S. Department of Health and Human Services announcement of a proposed new "go live" date, there seems to be a lot of activity involving procurement of ICD-10 mapping and crosswalk tools.

Concurrently, we are seeing an evolution in philosophy relating to the management of codes and mappings, something that will influence buyer decisions regarding the types of tools to incorporate into an ICD-10 program.

In considering mapping and crosswalk tools, leading companies are viewing the problem from an ongoing operational perspective and not simply from a transition/conversion lens. The idea is that the complexity of ICD-10 is not limited to encompassing a one-time transition or conversion.  Rather, the complexity will continue to be an issue well after Oct. 1, 2014.

Here are some reasons for this:

• The number of codes, and code volatility: between the ICD–9 and ICD–10 code sets, there are roughly 160,000 codes, and they are far from static. Consider the 2012 updates (which were made during a period of a "code freeze"), which introduced about 4,800 adds/deletes/changes to codes and several thousand mapping changes. We can expect such volatility for the next several years as well.

Managing the adoption of these changes requires a lot of work, including:

• Analyzing the impact of changes/deletions;
• Determining how to apply the new codes with other identifiers;
• Mapping/relating the new codes to other enterprise artifacts (benefit tables, code lists, charge masters, medical policies, etc.);
• Notifying the “owners” of these artifacts about the changes; and
• Flowing the changes to downstream systems and processes.

Most crosswalk and mapping tools will help with navigating these changes and analyzing the impacts to mappings, but they will not help with these other analytic tasks, which represent a significant challenge without some type of assistance.

• Codes don't exist in a vacuum; in most healthcare organizations, ICD codes are incorporated into lots of artifacts with ties to lots of processes and systems, both transactional and analytical. ICD-9/ICD-10 codes also are often found in lists (used to represent aggregations of codes, such as “all diabetes codes,” etc.), benefit tables (indicating which codes are payable under various circumstances), medical policies (identifying which procedures are applicable for which diagnoses, etc.), charge masters, DRG lists and more. These artifacts also tend to require other types of codes, such as CPT and HCPCS codes, to interface with the ICD-9/ICD-10 codes.

Simply storing and managing ICD-9/ICD-10 codes and GEMs/reimbursement mappings (and value-added mappings) is necessary, but not sufficient when it comes to successfully managing ongoing operations while using the ICD-10 code set. We believe that it is imperative to centrally manage these codes in conjunction with other types of codes and interface them with other artifacts (beyond mappings) that will come into play in downstream processes and systems.

We see our more progressive clients implementing master data management systems to handle mapping and crosswalk transition needs and also to address the ongoing operational requirements of adopting code/mapping updates and relating the ICD codes to other codes and artifacts. These solutions have been labeled “enterprise code set repositories,” or “encyclopedias,” and are being established as centralized, governed, enterprise storage points for codes (ICD, HCPCS, DRG, CPT, etc.), mappings and other key artifacts comprised of codes.

About the Author

John Wollman is the Executive Vice President of Healthcare for HighPoint Solutions, a Management and Information Technology consulting firm focused on Healthcare and Life Sciences.  John is responsible for HighPoint’s Healthcare industry group, catering to Payers and Providers.  John is a recognized expert in several healthcare business domains (Reform, HIPAA 5010, ICD-10, Platform Strategy) and technical domains (Master Data Management, Analytics).  Since graduating from Duke University, John has held executive level positions at consulting and technology companies over his 25 years in business.

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