ICD-10: Translation 101

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Original story posted on: March 30, 2014

Never let it be said that the implementation of ICD-10 has not been exciting.

ICD-10 is still a critical project that will continue to require our full attention. One of the areas of implementation that seems to create the most anxiety is translation. So let’s talk about it.

You’ve probably heard about the concept a hundred times and in several ways, such as mapping, crosswalking, translating, converting, etc. But what does it really mean? And what is the best verb to describe it? I offer, for your consideration, a breakdown of the verbs that are associated with the act of identifying the ICD-10 counterpart for a given ICD-9 code, or vice versa:

  • Mapping – Using a starting point (ICD-9 code) and plotting an end point (ICD-10 code).

  • Crosswalking – Identifying a code that is the equivalent of a starting code (ICD-9 or ICD-10).

  • Converting – Changing policies, processes, and systems from current ICD-9 logic to ICD-10 logic, including the codes themselves.

  • Translating – Using all methods available (including mapping, crosswalking, and converting, along with review of business requirements, clinical equivalence and appropriateness, and standard coding methodologies and guidelines) to identify the equivalent code or codes in ICD-10.

Many people use these terms interchangeably, but I am here to offer a little perspective, having done all of the above with my own two hands. These are not the same actions, but each can be a step in a much larger process that we all must embark upon if we are to implement ICD-10. We can’t use just one technique and call it a day. Case in point: we have all heard of the general equivalence mappings, or GEMs, that were developed by the Centers for Medicare & Medicaid Services (CMS) and 3M and released for free to the public for use in the transition to ICD-10. These mappings are also the standard “crosswalk” as required by the Patient Protection and Affordable Care Act. But these mappings, of which only a small percentage could be considered an actual “crosswalk,” are only a starting point in a much larger process. Look at this statement found in the GEMs User’s Guide:

“There is no simple ‘crosswalk from I-9 to I-10’ in the GEM files. A mapping that forces a simple correspondence — each I-9 code mapped only once — from the smaller, less detailed I-9 to the larger, more detailed I-10 defeats the purpose of upgrading to I-10. It obscures the differences between the two code sets and eliminates any possibility of benefiting from the improvement in data quality that I-10 offers. Instead of a simple crosswalk, the GEM files attempt to organize those differences in a meaningful way, by linking a code to all valid alternatives in the other code set from which choices can be made depending on the use to which the code is put.”

A simple solution is not always the best solution, and the translation process is anything but simple. In fact, it is a dynamic process that can change between business areas based on the use of codes or code data. Not everyone uses the codes in a standard way. If we’re completely honest, not everyone applies the codes according to the official coding guidelines. What we code is wholly determined by our understanding of the codes and how to apply them. The same is true for how codes are used within a payor system and how claims processing and adjudication rules are coupled with codes in the systems. Therefore, a standard “crosswalk” is not a solution based in reality in today’s healthcare environment.

But we shouldn’t feel defeated or start looking at ICD-10 implementation as some sort of insurmountable obstacle. Instead, let’s set aside our frustrations, breathe, and take a moment to assess what needs to be done to translate our ICD-9 world into the language of ICD-10. Here are some tips to get you started:

  1. Assess and prioritize what requires modification. Because the implementation clock is ticking, don’t waste your precious time on efforts that can wait until after the implementation date has come and gone. Focus on what absolutely needs to get done in time for testing and ahead of implementation.

  2. Take stock of your internal coding expertise. Leverage the human resources you have to help in any translation efforts you may have going on, regardless of whether they are expert coders or know “just enough to be dangerous.” Get started and assess where your gaps in knowledge are.

  3. Identify your clinical resources. Clinical knowledge may be all you need to address any gaps that can’t be filled by your coding expertise. Sometimes it’s only a small piece of the puzzle that will yield the solution.

  4. Take advantage of free resources – GEMs and ICD-10 manuals are available free of charge through CMS (www.cms.gov/Medicare/Coding/ICD10) along with the new Road to 10 provider portal (www.roadto10.org). Start by familiarizing yourself with the ICD-10 code set using the manual, and then you can begin any translation by looking up your ICD-9 codes in the GEMs. Use the manuals, which provide coding guidelines, to identify any codes that the GEMs do not identify. Remember, the GEMs are only an approximation.

  5. Align your translations with your business requirements. Translation does not end with the identification of the appropriate ICD-10 codes. Review your translations in the context of your business requirements. Some ICD-10 codes may not be applicable, and there may be additional gaps that will need to be addressed.

  6. Create a review and approval process. Employ more than one set of eyes to review the translations, ensuring that all solutions are as complete and accurate as possible. Formalize the approval process by identifying the owner of the process, and make sure he or she is responsible for approving any translation solution along with when the approval was given.

  7. Archive your translation solutions. Who knows what will be needed in terms of documentation, post-implementation, so make sure you have all solutions and their related information archived and available for future reference.

Don’t sweat the small stuff. And don’t bite off more than can be chewed properly before October 1, 2015. But do get started sooner rather than later!

About the Author

Mandy Willis is a Certified Coding Specialist and AHIMA Approved ICD-10 Trainer with 15 years of experience in the healthcare industry. She has worked in the small physician practice environment, commercial payer and Medicare and Medicaid. Currently, her focus is on assisting all sectors of the healthcare industry in making the transition to ICD-10.

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Mandy Willis, CCS, CPEHR

Mandy Willis is a Certified Coding Specialist and AHIMA Approved ICD-10 Trainer with 15 years of experience in the healthcare industry. She has worked in the small physician practice environment, commercial and public payers. She is also co-chair of the Workgroup for Electronic Data Interchange (WEDI) ICD-10 Coding and Translation Subworkgroup. Currently, her focus is on assisting all sectors of the healthcare industry in making the transition to ICD-10.