Automation tool- converts ICD-9 edi claim file to ICD-10 edi claim file.

http://urtesting.blogspot.com/

One of my friend has developed a automation tool that takes the icd9 claims as input and generates icd-10 brand new claims.The tool does the GEMs X-walk for icd 9 to icd 10 codes and also changes the date of service to service to a void the duplicate claim. I tested this and worked perfect for my testing.He is soon going to checkin the code in girth hub as open source.
Any one is interested please let me know.
This is a fantastic tool that also has the x-walk ability .
Urtesting.blogspot.com

HIPAA Transaction impacted by ICD-10 codes

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There are many transaction that are going to be impacted by ICD-10 diagnosis and procedure codes. Offcousre the 837 insutional and professional claims has a huge impact but almost all the most used HIPAA transaction has impact except the 835 transaction.
834 has a impactd when enrolling a member for pre-existing condition where Diagnosis code comes in 834 edi files.There is an impact on 270 and 271 transaction for claims status and also for 278 for referral when provider is referring for a condtion that has a diagnosis code.

837 - Profession - has a impact
837 - Instuitional - has a impact
837 - Dental - has a impact

270 - has a impact
271- has a impact

278 - has a impact.

835 - No impact .. but there need to a testing of 835 for the ICD-10 claims for making sure that 835 generates as expected for ICD-10 837 edi files.

Please feel free to comments ..and ask any question if you have..

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

Test Data Creation

http://urtesting.blogspot.com/

Most of the time during testing we put any data in application and test the application behavior and some how thats ok as far as testing team is concern. most of the time we need the valid test data in our test cases similar to the production test data or UAT test data or infact we need the  test data  to validate from a vast array of data .
lets assume we need  the test data for address or telephone number in US or UK  - in this case  we put the test data of our nation and assume that it will workk for US or UK without knowing the pattens of US or UK address or better say the telephone number where the format vary from nation to nation.As a test engineer always in the shoes of end user must replicate the near real test data.

Same problem was with me , as I used to put any junk data and proceeds for testing ,but that was not acceptable as long as you becomes the senior in corporate ladder.

I resolve the problem of Test data that is some how the real test data.

There is a site  -http://www.generatedata.com/#generator 

that generated the test data for testing purposes . And it has the functionality of export in different format as Excel, XML ,HTML etc.