ICD-10 Myth Buster: Is the ICD-10 implementation really just a simple code mapping effort?

Many people still believe that the new ICD-10 CM and PCS code set transition from ICD-9-CM will simply involve one-to-one mapping, but it will also require one-to-many general equivalency mappings (GEMs). This will require analysis, system reconfiguration, and thorough staff training.

One-To-Many Example

With the new ICD-10 coding, sports injuries will be coded with the sport and reason for the injury. Here’s the difference between ICD-9 and ICD-10 coding for sports injuries:

ICD-9 Code

  • Striking against or struck accidentally in sports without subsequent fall (E917.0)

ICD-10-CM Detail Codes

  • W21.00 Struck by hit or thrown ball, unspecified type
  • W21.01 Struck by football
  • W21.02 Struck by soccer ball
  • W21.03 Struck by baseball
  • W21.04 Struck by golf ball
  • W21.05 Struck by basketball
  • W21.06 Struck by volleyball
  • W21.07 Struck by softball
  • W21.09 Struck by other hit or thrown ball
  • W21.31 Struck by shoe cleats Stepped on by shoe cleats
  • W21.32 Struck by skate blades Skated over by skate blades
  • W21.39 Struck by other sports foot wear
  • W21.4 Striking against diving board
  • W21.11 Struck by baseball bat
  • W21.12 Struck by tennis racquet
  • W21.13 Struck by golf club
  • W21.19 Struck by other bat, racquet or club
  • W21.210 Struck by ice hockey stick
  • W21.211 Struck by field hockey stick
  • W21.220 Struck by ice hockey puck
  • W21.221 Struck by field hockey puck
  • W21.81 Striking against or struck by football  helmet
  • W21.89 Striking against or struck by other sports equipment
  • W21.9 Striking against or struck by unspecified sports equipment

That’s right, there are 24 possible ICD-10-CM detail codes to represent sports injuries, compared to only one ICD-9 sports injury code. This is just one of many examples that busts the myth that this is a simple one-to-one mapping effort.

For more information on the ICD-10 code impacts, contact HCIM Client Services at services@hcim.com or 888-454-0202, ext. 3.

About HCIM

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered expert consulting services and robotic automation tools for small to mid-sized healthcare payer and managed care organizations. Our concierge consulting services include everything from core claims system procurement to go live, including configuration, migration, upgrades, reporting, benefits and fee schedules, user training, and project resourcing. We also offer strategic consulting in the areas of value based payments, population health, medical management, medical loss analysis and recovery, care management, provider contract modeling, data analytics, and business process reengineering/analysis.

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