Duplicate Diagnosis codes in ICD-9 and ICD-10

http://urtesting.blogspot.com/

if your system is not storing ICD-9 and ICD-10 codes in your database with its type code then you are going to be in trouble. There are E codes ( External cause of Injury codes) that are both in ICD-9 and ICD-10 codes .
I queried the GEMS X-walk and found that there are total 34 E-codes that are same in ICD-9 and ICD-10.

here is a list based on Gems files for forward mapping :

E8020
E8029
E8300
E8301
E8309
E8310
E8319
E8330
E8331
E8332
E8339
E8340
E8341
E8342
E8349
E8350
E8351
E8352
E8359
E8381
E8389
E8411
E8419
E848
E851
E8801
E8809
E8840
E8841
E8842
E8849
E8881
E8889
E895

interesting thing to note that even these codes are equal but there description is different e.g
ICD-9 codes : E8020 its description is Railway accident involving derailment without antecedent collision injuring railway employee where as for ICD-10 its description is Unspecified porphyria

make sure to have your database distinguish the ICD-9 and ICD-10 codes otherwise all the claims processing and data analytics will have problem .

- post a comment if you have any and subscribe to my post for any update.

What next after ICD-10 implementation

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We might be thinking what next after ICD-10 implementation. The Answer is HPID( Health Plan ID) similar to NPI ID for Providers. Thats one of the way CMS is simplyfing the eHealth process.

More detail is available in CMS website.

CMS link for HPID

How to prepare ICD-10 EDI claims file from existing ICD-9 files or convert ICD-9 files to ICD-10 files( Part-2)

http://urtesting.blogspot.com/
This is in continuation of part-1...
HIPAA 5010 ICD-9 claims with conversion to ICD-10 claims. This example has a ICD-9 diagnois code 0340 that has 2 ICD-10 X-walk .. so 2 ICD-10 EDI files has been created for testing.

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ICD-9 Professional Claim example

ISA*00* *00* *ZZ*Sender *ZZ*Receiver *130915*1025*^*00501*201309150*1*T*:~
GS*HC*Sender*Receiver*20130915*1020*123456*X*005010X222A1~
ST*837*2013*005010X222A1~
BHT*0019*00*23456*20130915*1023*CH~
NM1*41*2*Sender Name*****46*Senderid~
PER*IC*ContactPersonName*TE*TelephoneNumberofContactperson*FX*FaxNumber~
NM1*40*2*ReceiverName*****46*ReceiverID~
HL*1**20*1~
NM1*85*2*Billing provider name*****XX*NPI~
N3*Billing Provider Address~
N4*Billing provider city*Billing provider State*Billing Provider Zipcode~
HL*2*1*22*0~
SBR*P*18*Subscriber group ID******BL~
NM1*IL*1*Subscriber Last Name*First Name*Middle Name***IL*subscriberid~
N3*Subscriber address~
N4*Subscriber city*state*zipcode~
DMG*D8*SubscriberDOB*SubscriberSEX~
NM1*PR*2*PayerName *****PI*payerID~
N3*PayerAddress~
N4*PayerCity*PayerState*Payerzipcode~
CLM*claimNumber*100***13:B:1*Y*A*Y*Y*P~
HI*BK:0340~
NM1*82*1*rendering provider name*****XX*NPI~
LX*1~
SV1*HC:99214*100*UN*1***1**N~
DTP*472*RD8*20130910-20130910~
SE*30*2013~
GE*1*123456~
IEA*1*201309150~

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First ICD-10 claim for the above ICD-9 claim
ISA*00* *00* *ZZ*Sender *ZZ*Receiver *130915*1025*^*00501*201309150*1*T*:~
GS*HC*Sender*Receiver*20130915*1020*123456*X*005010X222A1~
ST*837*2013*005010X222A1~
BHT*0019*00*23456*20130915*1023*CH~
NM1*41*2*Sender Name*****46*Senderid~
PER*IC*ContactPersonName*TE*TelephoneNumberofContactperson*FX*FaxNumber~
NM1*40*2*ReceiverName*****46*ReceiverID~
HL*1**20*1~
NM1*85*2*Billing provider name*****XX*NPI~
N3*Billing Provider Address~
N4*Billing provider city*Billing provider State*Billing Provider Zipcode~
HL*2*1*22*0~
SBR*P*18*Subscriber group ID******BL~
NM1*IL*1*Subscriber Last Name*First Name*Middle Name***IL*subscriberid~
N3*Subscriber address~
N4*Subscriber city*state*zipcode~
DMG*D8*SubscriberDOB*SubscriberSEX~
NM1*PR*2*PayerName *****PI*payerID~
N3*PayerAddress~
N4*PayerCity*PayerState*Payerzipcode~
CLM*claimNumber*100***13:B:1*Y*A*Y*Y*P~
HI*ABK:J020~
NM1*82*1*rendering provider name*****XX*NPI~
LX*1~
SV1*HC:99214*100*UN*1***1**N~
DTP*472*RD8*20130910-20130910~
SE*30*2013~
GE*1*123456~
IEA*1*201309150~

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Second ICD-10 claim for the above ICD-9 claim

ISA*00* *00* *ZZ*Sender *ZZ*Receiver *130915*1025*^*00501*201309150*1*T*:~
GS*HC*Sender*Receiver*20130915*1020*123456*X*005010X222A1~
ST*837*2013*005010X222A1~
BHT*0019*00*23456*20130915*1023*CH~
NM1*41*2*Sender Name*****46*Senderid~
PER*IC*ContactPersonName*TE*TelephoneNumberofContactperson*FX*FaxNumber~
NM1*40*2*ReceiverName*****46*ReceiverID~
HL*1**20*1~
NM1*85*2*Billing provider name*****XX*NPI~
N3*Billing Provider Address~
N4*Billing provider city*Billing provider State*Billing Provider Zipcode~
HL*2*1*22*0~
SBR*P*18*Subscriber group ID******BL~
NM1*IL*1*Subscriber Last Name*First Name*Middle Name***IL*subscriberid~
N3*Subscriber address~
N4*Subscriber city*state*zipcode~
DMG*D8*SubscriberDOB*SubscriberSEX~
NM1*PR*2*PayerName *****PI*payerID~
N3*PayerAddress~
N4*PayerCity*PayerState*Payerzipcode~
CLM*claimNumber*100***13:B:1*Y*A*Y*Y*P~
HI*ABK:J0300~
NM1*82*1*rendering provider name*****XX*NPI~
LX*1~
SV1*HC:99214*100*UN*1***1**N~
DTP*472*RD8*20130910-20130910~
SE*30*2013~
GE*1*123456~
IEA*1*201309150~

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in the above example of ICD-9 to ICD-10 conversion .. everything is remains same except the HI qualifiers and X-walk.
I have created a utility that takes the ICD-9 claims and creates all possible ICD-10 claims. Please let me know if someone is interested. Next post I will give some examples of Institutional claims with Diagnosis and procedure codes.

Disclaimer - The post is for educational purposes and help to prepare well for the ICD-9 to ICD-10 conversion. Above example just help to understand the 837 changes for ICD-10 claims. Please do not use this claims in your testing as it will not work as data has been masked for security and confidentiality.

How to prepare ICD-10 EDI claims file from existing ICD-9 files or convert ICD-9 files to ICD-10 files - Part1

http://urtesting.blogspot.com/

A quick guide to prepare ICD-10 Edi files

There are 2 change that need to be done to prepare ICD-10 claim from existing ICD-9 claims 

1. Daignosis and procedure code Qualifers mapping and
2. ICD-9 to ICD-10 mappings( using GEMS or any custom X-walk by any vendor)

Qualifers Mapping

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ICD-9 Qualifer	Qualifers Definition	ICD-10 Qualifers
BK	Primary Diagnosis code	ABK
BF	Secondary Diagnosis code	ABF
BN	External Cause of injury	ABN
BJ	Admitting Diagnosis	ABJ
PR	Patient Reason for Visit	APR
BR	Primary Procedure code	BBR
BQ	Secondary Procedure code	BBQ

note : there are some HI qualifers like DR for DRG HI*DR, value codes HI*BE, conditon codes , occurance codes has no change from ICD-9 to ICD-10 codes

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2. Gems X-walk

Use the CMS published GEMS X-walk for ICD-9 codes to ICD-10 codes.

Here is a link to download the X-walk CMS GEMS

GEMS has 2 files to download - one is for Diagnosis code(CM)and other is for Proecdure code(PCS). Note that PCS codes are only applicable with Inpatient Instuitional claims.See my next post on details of Gems and how to x-walk the codes and how to decide on one to many code mappings.

if you have no knowledge of GEMS mapping , you can use this widget to X-walk ICD-9 to ICD-10 provided by aapc.

Example

To convert ICD-9 to ICD-10 claim files, entire HIPAA 5010 837 EDI file remain same except the HI segement.

e.g ICD-9 claim HI segment with one of the most used Princiapl diagnosis code ( 0340 -shore throat) with Secondary diagnosis code -V202 for - child well visit.

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HI*BK:0340*BF:V202~

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ICD-10 HI segment: the ICD-9 Principal diagnosis code 0340 has 2 X-walk for ICD-10 CM codes J020 and J0300, I have selected the J020 as it is more specified for this example, you may create 2 edi files one for each diagnosis code.( Note :to select the best code See the description of codes or use the backward mapping to select the best usally the medical codes assigne the codes by reading the patient medical record or charts)

The secondary ICD-9 diagnosis code V20.2 (chid visit) has ICD-10 x-walk :Z00129.

here is ICD-10 HI segment after the X-walk and Qualifier mapping

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HI*ABK:J020*ABF:Z00129~

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Apart from the HI segment change there is nothing has changed in ICD-10 claims .The LX segment that contain the service lines details contains the HCPCS /CPT code and that is same as it is in ICD-9 codes. You might be woundering then how the pricing is going to be different as price is charged for every HCPCS/CPT codes. This I will explain in next post.Also I will cover the gems in details for why back-ward mapping from ICD-10 to ICD-9 is important for X-walk. Please feel free to leave a comment and send an email - urtesting@gmail.com , if you have any clarification.

See my next post for 837 EDI files examples in details