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

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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