ICD Mapping and Search Tool  
This ICD Tool is intended to make your transition to ICD-10 easier. With sophisticated crosswalking capabilities, it has been specifically designed to blend with the current workflow of UniCharts EMR and also takes into account the fact that users are required by the CMS to keep on using ICD-9 until 30th September and then abruptly switch to ICD-10 on 1st October 2015, the very next day.

 Are you relying on your biller to do ICD-10 coding for you or plan to select ICD-9 in the EMR to be converted to ICD-10 by your biller down the stream? If yes, it would be a bad idea after all. ICD-10 codes contain additional information about laterality, anatomical site, severity, alignment and the encounter stage (even the obstetric codes identify trimester of pregnancy) and only the physician at the point of care can provide this information accurately. For example, the ICD-9 diagnosis code for burn does not distinguish whether the burn is on the right or left arm whereas the ICD-10 diagnosis code set has specific codes for right versus left. As such, the only way a biller could select an ICD-10 code on your behalf is to select a code option saying "unspecified" burn site (which most payors will not accept anyways) or else you will need to provide additional documentation to the biller so that an accurate code could be selected. And one day you will have to convert to ICD-10 not matter what. Then why not now?

The contents of this guide are as follows:

TOOL INSTALLATION


The ICD Tool is available as an online software update. You just need to purchase an activation key and update the EMR online. Restarting the EMR after entering the activation key and online update will automatically install the tool and it would become available for immediate use.




TOOL FEATURES


  1. The tool provides forward-mapping of ICD-9 to ICD-10 from within the EMR system. Mapping is done for all more than 16,000 ICD-9 codes, if a mapping exists.



  2. The tool automatically does the backward-mapping of ICD-10 to ICD-9 in the background to provide the user with additional choices wherever possible and facilitate their decision making process.



  3. The tool provides AUTO-MAPPING of ICD-9 to ICD-10 from within the EMR system. This is different than the manual mapping mentioned above where user has to enter the ICD-9 he or she wants to map. This feature of the tool automatically intercepts the ICD-9 that user selects from the Favorite List and presents to him or her the mapped ICD-10, be it one ICD-10 code or many.



  4. The tool provides searching of ICD-10, both through their codes and short descriptions, from within the EMR system. Searches are conducted on the complete ICD-10 database of more than 91,000 codes.



  5. The tool provides mechanism to replace all ICD-9 codes saved in the "Favorite List" of the EMR with their corresponding ICD-10 codes, both forward-mapped and backward-mapped. The entire conversion is achieved just by a click of a conversion button.







RECOMMENDATION FOR A SMOOTHER TRANSITION


Although it is your discretion and you may convert your entire ICD-9 favorite list to ICD-10 codes on 1st October using the conversion button mentioned above, we recommend using the auto-mapping feature for a few weeks or months until the providers become familiar and comfortable with ICD-10 codes. That is, leave the current ICD-9 codes in your Favorite List as they are and just continue clicking on them for the time being. The auto-mapping would automatically intercept the selected ICD-9 code and present appropriate ICD-10 replacement/s to the user. The user may then click on the applicable ICD-10 to copy it to the chart form as they normally do. In case a mapping is not found (may occasionally happen as few ICD-9 codes have no corresponding ICD-10 codes), the user can always go to the "Search ICD-10 Database" tab of the tool to search a database of more than 91,000 codes and select an appropriate code from the search results that are presented to them. Please be aware that if you have a mix of ICD-9 and ICD-10 codes in your Favorite List, the auto-mapping is capable of making a distinction and would not intercept an ICD-10 code but instead send it directly to the chart form, as shown below. Just note that there are certain codes which are present in both ICD-9 and ICD-10 code-sets but have completely different descriptions, V82.2 for instance. In such a case, the auto-mapping will treat that code as an ICD-9 code and present its ICD-10 counterpart to the user for selection as appropriate.







NOTES FOR CLINICAL USERS


Providers will mostly encounter three categories of mappings while using the forward-mapping tool. These are "Precise mappings", "Approximate mappings" and "Combination mappings", with the combination mapping further falling into a "Complex" type on rare occasions. The following table explains these mapping types and also discusses the aspects to consider while making a selection.
Precise Mappings:
Also called "Exact" mappings, about 24% of all ICD-9 to ICD-10 code mappings fall into this category. These codes are one-to-one exact match such as the ICD-9 code 157.0 - Malignant neoplasm of head of pancreas maps precisely to ICD-10 C25.0 - Malignant neoplasm of head of pancreas. When mapping results are displayed in the tool, the category of the results is always displayed on the top right corner of the window, as shown in the image on right. And with the status showing "Precise Mapping", they may be selected by the provider right away without any further consideration.
Approximate Mappings:
This is the largest category with about 68% of mappings falling under it. Out of this percentage, most are one-to-one approximate matches with a single choice such as ICD-0 530.85 - Barrett's esophagus maps approximately to ICD-10 K22.70 - Barrett's esophagus without dysplasia. In these cases the two codes have similar meanings and as there is only one choice available, the provider may select it without any further consideration.
However, there are mappings under this category that present one-to-one approximate matches with multiple choices such as ICD-9 155.0 - Malignant neoplasm of liver, primary maps approximately to ICD-10 C22.0 - Liver cell carcinoma, or C22.2 - Heptablastoma, or C22.7 - Other specified carcinomas of liver or C22.8 - Malignant neoplasm of liver, primary. In such cases the provider should further review each of the approximate mappings and determine the most appropriate approximate match to select.
Combination Mappings:
About 5% of the mappings fall under the "combination" category where an ICD-9 code must be linked to more than one ICD-10 code to be a valid entry. For example, the ICD-9 115.11 - Histoplasma duboisii meningitis is a combination code that maps to ICD-10 B39.5 - Histoplasmosis duboisii AND G02 - Meningitis in other infectious and parasitic diseases classified elsewhere. Also note that in some rare cases a combination mapping may be of "complex" type representing multiple code combinations and alternatives. For example, a query may result in a combination mapping showing two or more sets with each set comprising of two or more ICD-10 codes. In such cases, the provider should make selections according to the scenario and on the basis of their judgment and medical intent.
No Mappings:
About 3% of the ICD-9 codes do not have any forward-mapping with ICD-10 codes. In such cases the tool will give you a message to that effect, as shown on right. However, a no-mapping does not mean there is no ICD-10 code available to cover the clinical context you are dealing with. In fact there may be multiple ICD-10 codes appropriate for that situation and all you need to do is conduct a search on the "Search ICD-10 Database" tab of the tool.
In many cases where there is no mapping available, the tool may still display other related codes that it extracts by automatic backward-mapping from ICD-10 to ICD-9. Also note that while it is perfectly okay to use the mappings and/or related codes where they are available, there is nothing preventing you to conduct a search to seek for a better alternative even when a mapping is available. ICD-10 is many times vast than the ICD-9 and a direct search of ICD-10 code-set may result in code options that are even better and more relevant than the options that crosswalking may provide.
Note that the tool will look slightly different when you will open it from the Ongoing Problems section on the Encounter form. Unlike New Assessments section, there will be not tab for the ICD-10 searching and the mapping field would also be readonly. This is because user in the Ongoing Problems section is only supposed to convert the ICD-9 codes already present in the ongoing problems list and no more. So just click on the desired ICD-9 in the ongoing problems list above and select from the ICD-10 options that the tool presents. In rare case if a mapping does not exist, you should remove that code from the "Master Problem List" of that patient and select an appropriate ICD-10 in the New Assessments section instead.

 How to deal with the ICD-9 codes present in the "Master Problem List" on the HISTORY form of charts? The best way to deal with "Master Problem List" would be to just focus on the codes you select for the Ongoing Problems section on the encounter form during a visit. Even if there are 20 codes in the "Master Problem List" of a patient, you will probably deal with a just few during a particular visit. And converting those codes to ICD-10 in the ongoing section will also convert those codes to ICD-10 in the Master Problem List on the History form. This way all the codes in the Master Problem List will gradually convert to ICD-10 with the passage of time.
Finally, take advantage of the time you have before the 1st October 2015 arrives. We recommend you make a dummy chart/encounter within the EMR and play with the ICD Tool in your free time to get as much exposure to ICD-10 as possible. Your EMR administrator would probably make the "Auto Map" feature permanently enabled on 1st October but before that date you can manually enable/disable it for practicing purposes. Just be aware that once you manually enable it, it would remain enabled until either you manually disable it or exit the session by closing the browser window or logging out.



NOTES FOR ADMINISTRATORS


There are two ICD Tool related settings that the clinic administrators need to be aware of. First setting is about enabling and disabling of the ICD Tool itself. When you will update online and enter activation key, the ICD Tool will be become automatically enabled and visible to all users that have access to "Favorite List" window. However, when the time comes where you feel there is no more need for the tool or in case you need to disable it for any other reason, just un-tick the checkbox shown in the screenshot below and the tool will go away from "Favorite List" windows of all users on their subsequent logins. You may enable the ICD Tool again at any time you want just by ticking the checkbox and saving the setting in question.



The second setting is about enforcing the use of Auto-Mapping feature of the ICD tool. We recommend that you tick this checkbox on the morning of 1st October 2015 to enforce the automatic mapping to ensure no ICD-9 code inadvertently gets into the chart forms from that point onwards. After this setting would take effect, the Auto-Map checkbox on the tool will become permanently enabled and cannot be disabled by the user, as shown below.





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