Wiki Question for coders who work at MCO's or Payers

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mdfield01

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The company I work for, as part of their ICD10 implementation, is planning on using the GEM crosswalk for any professional claim submitted by a physician office with an ICD9 code...with no cut off date.

I, personally, think this is a HORRIBLE idea, but maybe its just me. My personal opinion is that if a physician practice submits a claim with an ICD9 code after the cut off the claim should be rejected.

Are any of you who work in a claim processing environment using the GEM crosswalk this way? Just curious.

Michael
 
mdfield01 said:
The company I work for, as part of their ICD10 implementation, is planning on using the GEM crosswalk for any professional claim submitted by a physician office with an ICD9 code...with no cut off date.

I, personally, think this is a HORRIBLE idea, but maybe its just me. My personal opinion is that if a physician practice submits a claim with an ICD9 code after the cut off the claim should be rejected.

Are any of you who work in a claim processing environment using the GEM crosswalk this way? Just curious.

Michael
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I work for a provider, not a payer, but I'd like to give my concern with this.

Our EMR has similar mappings, so all the ICD9 codes we've entered into the patients' problem lists and assessments shows the mapped ICD10 code, since last summer. In reviewing these, I've found that most of the crosswalks from 9 to 10 go to unspecified codes, which pretty much defeats the purpose of using ICD10. There's also a few that have a 1:1 ratio that did not get mapped. I'm not sure how this compares with the GEMs--I've glanced through it, but have not compared any specific codes--so this may not be an issue with the GEM files. Just wanted to point it out.

I agree that it isn't a good idea to crosswalk them. Our payers have all indicated that any claims filed after 10/1 with ICD9 will not be processed.

HTH some!
 
The crosswalks are not a good idea. CMS has stated that these should not be used for coding payient claims. They were only intended to be used for data capture. Many codes have been incorrectly used in ICD-9 and when mapped over to ICD-10CM the code reads so differently that it does not fit the patient. Also there are numerous codes in ICD-10CM that are new and have no ICD-9 code that can map over to it. Such as repeated falls and unhappiness, and worries.
 
I work for an MCO and we will not accept ICD9 codes come October - your claims will be rejected if you don't submit with ICD10 codes.
 
I work for a state Medicaid and claims coded with ICD-9 codes with DOS 10/01/2015 or later will be rejected.

As others have stated before this post the crosswalk is not a one to one, it's a one to many. The claims will be paid incorrect if processed in the manor described.
 
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