Updated on: March 16, 2016

Maps: Excellent Tools, or Bad Road Ahead?

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Original story posted on: January 10, 2014

EDITOR’S NOTE: Holly Louie is the newest member of the ICD10monitor editorial board.

With the final countdown to ICD-10-CM implementation underway, more and more providers are looking for solutions to help them master the looming coding changes. Vendors are investing tremendous resources and marketing various solutions to meet these needs. Crosswalks or maps may seem like the answer to such coding challenges, but is it the whole answer, or even the right answer? 

 

Like all maps in current use, some work better than others. We all have seen the news stories about people who got lost, stranded, or directed to an incorrect location by map guidance technology that failed. Roads may or may not appear on paper or in the applications. Satellite guidance may be disrupted. One product may insist you make a left turn in the middle of a bridge. In other cases, the maps are lifesavers, giving perfect directions and accurate results.

Another key ICD-10 point often overlooked is that no matter the map or crosswalk selected, it is merely a tool to aid in identifying possible code choices. In a few cases, a 1:1 match from ICD-9-CM to ICD-10-CM will emerge. In the vast majority of cases, there will be an “approximate match.” Perhaps the most well-known product, General Equivalency Mappings (GEMs), says it all in the name, specifically in the first word. Once the possible equivalent codes are known and a selection of them are chosen, the work of validation must occur for accurate final code(s) designation to be completed. That work is accomplished by reading the coding instructions for each applicable scenario. Do you have to designate type of visit? Do the coding conventions state that there are inclusions or exclusions that must be considered? Are there requirements to report another code first, or in addition to the one chosen? In speaking with providers regarding how they select mapping tools, some interesting and enlightening information emerges. Unfortunately, these provider “must-haves” not only place increased pressure on vendors, but they potentially can result in lack of coding accuracy.

So, how can we help providers choose maps wisely? By recognizing and understanding their practice needs, operational requirements, financial resources, and the practical applications of each mapping tool(s) selected.

Let’s review some of the most common mapping tools in light of physician requirements, coding accuracy, and possible financial and compliance issues.

Superbills are still prevalent in many small physician practices, and how well mapping works is widely variable. For some specialties or subspecialties with a limited range of diagnoses, a superbill may be a reasonable option. The more diverse the specialty or practice, the more problematic a superbill becomes.

Will a physician really use 20 or 30 pages? Will they default to all unspecified codes, defying the specificity that is so highly sought? Will reimbursement be negatively impacted if only non-specific codes are reported or coding conventions are not followed? Will only a small subset of codes for a diagnostic category be included? Will the physician rely upon the ICD-10-CM book if an accurate choice is not on the superbill? Will improper coding result? A superbill may be an alternative, but review it carefully, educate each physician on the deficiencies, select codes wisely, and include instructions for cases that don’t fit the choices.

Some maps allow users to search by keyword, with all possible matches identified. Although this may sound like the optimum choice, in practice, physicians find it time-consuming and frustrating to work through all the possible options.

Anecdotal reports indicate that, when faced with too many choices, providers tend to select their favorites or only pick from the first three choices listed. The problems are compounded when coding is assigned to staffers who are not professional coders; they can become overwhelmed by all the choices, medical terminology, and the unfamiliar appearance of codes. Anything that takes more time away from patient care likely will be rejected or misused. Help physicians by allowing them and/or their staff to test-run the map, as it will work in their worlds, before they make an investment with no return.

Some very good maps further refine the selection tools to allow a user to narrow a search down quickly by simply checking some specific identifiers (such as laterality, upper or lower, type of visit, etc.) When the provider makes a selection, the rules appear along with a complete description, allowing for a quick review of code accuracy. This functionality seems to appeal to many providers and may result in more accurate coding.

Automated coding assistance tools also are gaining popularity. These maps typically include every available code choice and are programmed to incorporate coding conventions. However, the program must “learn” the words that indicate a specific ICD-10-CM choice. Extraneous comments may be assigned diagnosis codes, a history may be coded as a current condition, and gender or age discrepancies can arise. For at least some period of time, things may get lost in translation, so careful review is imperative (in one real-life example, a cervix became the cervical spine). Providers also will need time to learn how what they document will be interpreted so they can make any needed modifications. 

Anecdotal reports indicate that at least some providers have requested and/or been promised a mapping tool that incorporates only covered (paid) diagnosis codes. The long-ago seafaring warning “here be dragons” should probably be applied to such products. 

In conclusion, there are many maps to choose from. Some are excellent, some are not. The most important questions to ask before making a choice are these: Do the codes selected accurately represent what is documented in the medical record? Are the code choices adequate to assign the most specific choice to the documentation? Does the map provide the necessary information to identify the coding conventions for the choices or direct the user to the ICD-10 manual? Will the provider be able to use the map efficiently, effectively, and accurately? 

Maps are tools. Make sure they take you where you want to go.

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.
Holly Louie, RN, BSN, CHBME

Holly Louie is the compliance officer for Practice Management Inc., a multi-specialty billing company in Boise, Idaho. Holly was the 2016 president of the Healthcare Business and Management Association (HBMA) and previously chaired the ICD-10 Committee. Holly is also a national healthcare consultant and testifying expert on matters related to physician coding, billing, and regulatory compliance. She has previously held compliance officer positions in local and international billing companies. Holly is a member of the ICD10monitor editor board and a popular guest on Talk Ten Tuesdays.