READING the Fine Print
ON ICD- 10 CONVERSIONS
EVEN HIGHLY AUTOMATED CONVERSIONS REQUIRE REVIEW
Automation is a major help in converting to the ICD- 10 code set, but it is not a
magical solution. In fact, skipping a human review of converted systems exposes
an organization to legal and financial risk.
By Rhonda Butler, CCS, CCS-P; Ron Mills, PhD; and Rich Averill, MS
PEOPLE WHO ARE secondary users of coded medical records—
who see only the results of data analysis—may be quick to believe that converting to ICD- 10 is easier than it is. They usually
don’t have knowledge of ICD- 9 codes and coding, and they are
typically interested in codes only as a means to an end. So when
they are shopping for software or services and hear that ICD- 10
conversion can be fully automated using the General Equivalence Mappings, or GEMs, they have no reason to question it.
Tom Waits reminded us in his song “Step Right Up” that “the
large print giveth/And the small print taketh away.” In approaching an ICD- 10 conversion, the large print is alluring, but
the small print is essential reading.
The large print is this: ICD- 10 conversion can be highly automated.
The small print is this: ICD- 10 conversions cannot be fully
automated, and they cannot be finalized without review and evaluation by a person familiar with each system being converted.
Autoconverted ICD- 10 systems may not work as intended,
and skipping a human review can expose an organization to legal and financial risk once the converted systems go live.
The reasons conversions cannot be fully automated are not
technical. They come from significant differences in language
and structure between ICD- 9 and ICD- 10.
These unavoidable differences must be evaluated by a technical subject matter expert who has a solid understanding of the
system being converted in tandem with an HIM professional
familiar with both code sets. It is these subject matter experts
from both the systems and HIM realms who must resolve issues
exposed by a GEMs-based translation in the context of a particular system to ensure the converted ICD- 10 system works as
intended.
The good news, however, is that by using the GEMs, more than
90 percent of the code translation effort in applications, databases, policies, and contracts can be automated.
Poor Conversion in a Care Management Program
Any system containing ICD- 9 codes has a distinct purpose: to
find patients who share similar characteristics or meet specific
criteria. For example, a care management program can use ICD-
9 codes to identify patients with poorly controlled diabetes so it
