News: CMS maps MS-DRGs to ICD-10

Come October 2013, healthcare facilities will switch from reporting ICD-9-CM codes to the internally accepted ICD-10-CM code set.

 

CMS developed General Equivalence Mappings (GEMs) in order to help translate ICD-9 codes to ICD-10. Providers can use the GEMs “as a sort of a find and replace for codes,” said CMS senior technical advisor Pat Brooks, during the November 19, 2009, National Provider Conference Call

 ICD-10-CM/PCS Medicare Severity-Diagnosis Related Group Conversion Project.

 

When CMS developed the CEMs, Brooks says many wondered how well the tool would work once actual conversions were required. So, “the agency picked the most complicated payment system—the MS-DRGs—and used those GEMs to see how well they worked in converting that DRG system to ICD-10.”

 

The first part of CMS’ analysis focused on GEM conversions of just one part of the payment system, the digestive system (MDC 6). . CMS started with a goal that, to the extent possible, if the same patient received the same care, he or she would be assigned to the same payment group regardless of whether coders reported ICD-9 or ICD-10 codes.

 

CMS was able to convert about 99% of the diagnosis codes using the GEMs. With the remaining 1%, staff needed to read the narrative description, look at the DRG, and do some independent analysis to decide how to make the conversions, Brooks said. On the procedure code lists, additional analysis was required roughly 9% of the time.

 

The written and audio transcript summaries of the ICD-10-CM/PCS Medicare Severity - Diagnosis Related Group Conversion Project National Provider Conference Call were published on the CMS Web site in the downloads section.www.cms.hhs.gov/ICD10/06a_2009_CMS_Sponsored_Calls.asp