Monday, December 7, 2009

Can clinicians continue current practice and use the DSM-IV diagnostic criteria?

Question: In current practice by the mental health field, many clinicians use the DSM-IV in diagnosing mental disorders. Can these clinicians continue current practice and use the DSM-IV diagnostic criteria?
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Answer : Yes. The Introduction to the DSM-IV indicates that the DSM-IV is “fully compatible” with the ICD-9-CM. The reason for this compatibility is that each diagnosis listed in the DSM-IV is “crosswalked” to the appropriate ICD-9-CM code. The DSM-IV is not a HIPAA adopted code set and may not be used in HIPAA standard transactions. It is expected that clinicians may continue to base their diagnostic decisions on the DSM-IV criteria, and, if so, to crosswalk those decisions to the appropriate ICD-9-CM codes. In addition, it is still perfectly permissible for providers and others to use the DSM-IV codes, descriptors and diagnostic criteria for other purposes, including medical records, quality assessment, medical review, consultation and patient communications.
Question: What methodology is being used in the Medicare Severity Diagnosis Related Groups (MS-DRG) International Classification of Diseases, 10th Edition (ICD-10) conversion?
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Answer : The goal of MS-DRG ICD-10 conversion is to replicate the current MS-DRG logic. A record coded in ICD-10-Clinical Modification/Procedure Coding System (CM/PCS) and processed according to the converted ICD-10-based MS-DRGs will be assigned to the same MS-DRG as the same record coded in ICD-9-CM and processed according to the current MS-DRG logic.


We are accomplishing this goal by translating the lists of ICD-9-CM codes that comprise the MS-DRGs (approximately 500 code lists) to comparable lists of ICD-10-CM/PCS codes without changing the underlying MS-DRG logic. This method of replacing lists of ICD-9-CM codes with lists of ICD-10 codes is partially automated using the General Equivalence Mappings.

Can ICD-9-CM procedure codes be reported on hospital outpatient claims?

Can ICD-9-CM procedure codes be reported on hospital outpatient claims? If I use HCPCS codes to report hospital outpatient services at the “required” service line level segment for a claim, may I use the ICD-9-CM procedure codes to report hospital outpatient services at the claim level “situational” segment?
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Answer : NO. ICD-9-CM procedure codes were named as the HIPAA standard code set for inpatient hospital procedures. The ICD-9-CM procedure codes were not named a HIPAA standard for procedures in other settings such as hospital outpatient services or other types of ambulatory services. Hospitals may capture the ICD-9-CM procedure codes for internally tracking or monitoring hospital outpatient services; but when conducting standard transactions, hospitals must use HCPCS codes to report outpatient services at the service line level and the claim level, if the situation applies. Even though an ICD-9-CM procedure code qualifier is available, in addition to a HCPCS code qualifier, at the “situational” claim level segment, the Transactions and Code Sets regulation states that ICD-9-CM procedure codes is the adopted standard code set for hospital inpatient services.

For what period of time following International Classification of Diseases, 10th Edition (ICD-10) implementation on October 1, 2013 will the General E

Question: For what period of time following International Classification of Diseases, 10th Edition (ICD-10) implementation on October 1, 2013 will the General Equivalence Mappings (GEM) be updated?
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Answer : As we discussed on pages 3337-3338 of the ICD-10 final rule, the ICD-9-CM Coordination and Maintenance Committee will discuss updating the GEMs for a minimum of three years after ICD-10 is implemented on October 1, 2013. We welcome recommendations regarding how long the GEMs should be maintained and updated. The final rule can be found at http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf on the Web.

ICD-9-CM code

Question: The information in the introductions to the General Equivalence Mappings (GEM) points out that, in some cases, there is a clear one-to-one match between an International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) code and an International Classification of Diseases, 10th Edition (ICD-10)-CM or ICD-10-Procedure Coding System (PCS) code. However, one ICD-9-CM code often translates to several ICD-10-CM or ICD-10-PCS codes because of the nature of going from the more general ICD-9-CM to the more specific ICD-10. Please describe the methodology that was used to create the GEMs.
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Answer
In order to both create and maintain the GEMs, all reasonable code translation alternatives are included in its respective GEM, based on the complete meaning of the code being looked up. For example, for the ICD-9-CM to ICD-10-CM GEM, we look up an ICD-9-CM code and include all reasonable translation alternatives in that GEM based on the "complete meaning" of the ICD-9-CM code. The "complete meaning" of a code includes tabular instruction, index entries, guidelines, and applicable Coding Clinic advice.


There may be multiple translation alternatives for a source system code (the code being looked up), all of which are equally plausible. This is true of both the ICD-10 to ICD-9-CM GEMs and the ICD-9-CM to ICD-10 GEMs. When there is only one alternative in a GEM, we can say that we have a "one-to-one" translation. This is common in the ICD-10 to ICD-9-CM GEMs and does not necessarily mean the two codes are identical. Additional information about this subject can be found at http://www.cms.hhs.gov/ICD10/01m_2009_ICD10PCS.asp. On this page, select the file labeled "2009 Mapping - ICD-10-PCS to ICD-9-CM and ICD-9-CM to ICD-10-PCS; and User Guide, Reimbursement Guide, Diagnosis, and Procedures" to access the mapping files.