Ready for ICD-10’s Impact to Healthcare Integration?

09

JUNE, 2015

Healthcare Industry News
Healthcare Integration

With the October 1st ICD-10 compliance date now looming on the horizon, organizations are shoring up their plans for the transition.  Software upgrades and training plans around the changes to ICD-10 codes may well be underway, we want to ask the integration community—is your integration team ready?

The transition from ICD-9 to ICD-10 will affect several areas of healthcare integration and if teams and organizations are not prepared, the impact will be significant. To help prepare and equip the integration community for the upcoming changes, we want to take this opportunity to share with you a discussion initiated by some of our expert consultants.

The sheer increase in the number of codes from 13,000 in ICD-9 to 68,000 in ICD-10 presents many potential changes, but the 3 major areas of impact to the integration of data in the transition to ICD-10 are structural, validation, and translation.

The basic integration concern when moving to the ICD-10 code set is the structure of the fields used to contain the new code string versus the previous ICD-9 code set. While the minimum code length remains a three character string, the maximum code length increases from five to seven characters.

Because ICD-10 utilizes “full code titles” some consideration must also be given to the field length when transmitting these code titles. In most cases delimited rather than fixed length messages are being used so this issue of longer code titles can be accommodated easily by not enforcing a maximum length for this field.

A more complex integration issue to consider when moving to ICD-10 would be the modification of any validation services currently in use for ICD-9 codes. In addition to the maximum code length increasing from five to seven characters, the changes to the format of the code string must be considered. For ICD-9 codes the first character may be alpha character and characters 2-5 must be numeric. For the ICD-10 code-set character 1 is alpha, characters 2 and 3 are numeric, and characters 4-7 are alpha or numeric (alpha characters are also not case sensitive).

Any validation code or services currently based on the ICD-9 format must be modified accordingly for ICD-10. Also, for any validation services that perform a look-up operation to validate whether or not an incoming code is valid, these services must be modified to accommodate the new codes. Considering that the code set is increased from approximately 13,000 to approximately 68,000 this task may not be trivial.

Finally, the integration requirement that may present the biggest investment as well as the biggest risk would be in the case of disparity between sending and receiving systems with regard to which code system is supported. If one system supports ICD-9 while the other has moved to the ICD-10 code set there may be the need to translate from one code set to the other. The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) created General Equivalence Mappings (GEMs), also known as crosswalks, as a tool to help in the conversion of data from ICD-9 to ICD-10 and vice versa.

These crosswalks are not a substitute for full ICD-10 compliance, but designed to help during a period of time of the transition to help with data conversion, calculating reimbursement, tracking quality, and reporting. Since there is not a one-to-one match between ICD-9 and ICD-10, crosswalks are by definition inexact and much care must be taken to prevent loss of information and negative impact to the business.

To conclude, the transition to ICD-10, while primarily an application concern has some implications with regard to the integration of data that contains these codes. If you have concern for your integration efforts as you prepare for ICD-10 compliance, contact Core Health Technologies.