At a time when industry bodies and consultancies are trying to figure out how providers and payers can best transform existing ICD-9 data into the imminent ICD-10 code schemes, and the word “crosswalk” keeps being batted around, Dennis Winkler at Blue Cross Blue Shield Michigan is the curious case of an ICD-10 crosswalk contrarian, believing he's found a better path. Winkler, it seems, just might be onto something that appears revolutionary but in practice is not.
As Blue Cross Blue Shield Michigan's director of technical program management, Winkler and his team were inundated with all sorts of vendors telling them how hard the ICD-10 conversion was going to be, how many more codes there are, and why they desperately need a huge technical solution including application crosswalks. Rather than cowering into a confused state, however, Winkler recognized the dollar signs in the eyes of those vendors chomping at the bit, and figured out how to go it alone.
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“Right out of the chute, when we developed our team to start looking at the strategy, everyone was telling us how radically different this was going to be. And granted, there are differences in the field size, in the nomenclature, and as we understood the differences we kept saying, 'Isn’t there something we could do to look at it differently?'”
That answer, of course, is yes, and when they did Winkler and his team realized that by altering their existing systems and applications for the 7 digit ICD-10 codes, they'd be putting BCBS Michigan into a better position than if they opted to crosswalk from existing ICD-9 data to ICD-10. “As soon as we started looking it that way,” Winkler continues, “we started seeing more similarities in everything that we have to do, as opposed to the technical difficulties.”
Stanley Nachimson, co-chair of WEDI's timeline initiative, agrees. “Crosswalks are the quick-and-dirty fix that everyone is looking for,” Nachimson says. “Updating your systems and processes to accept and process ICD-10 codes is better for the future.”
If that sounds anything resembling easy, well, it’s not.
“There’s a huge amount of work that has to be done on the business side to accomplish this,” Winkler says. “The technical side turns out to be high-volume but low-complexity.”
WEDI’s Nachimson told ICD10Watch that ICD-10 is approximately 25 percent technology, and 75 percent a business issue. Agreeing, Winkler adds that BCBS Michigan broke it out by function, those being tasks the business performs versus what IT handles, to determine about a 70-30 split in which the largest impact is on the business side.
That reality is part of what makes the ICD-10 conversion so massive, as is the fact that crosswalks are not a panacea because there is no one-to-one map from ICD-9 to ICD-10, says Tori Sullivan, a manager in Capgemini's healthcare unit and co-chair of HIMSS ICD-10 task force.
“Every organization has to make business decisions on scenario bases for code translations that take an ICD-9 code into an ICD-10 code and backward,” Sullivan explains. “There has to be a business process within a business decision to support the change.”
That said, the CMS-3M crosswalks, of course, do have their place. Sharon Perkins, director of IT and the HIPAA Security Officer at El Paso First Health Plan, says her organization is planning to use the CMS crosswalk.
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“When you’ve got something with a greater level of specificity, you’re going to want to see what that one ICD-9 code was to the 50 that it may be on the ICD-10 side. And if you shore yourself up, and have a mapping for that specificity, the better results you’ll have from capitalizing on the greater information available at your disposal,” Perkins explains. “It’s going to be imperative that you’re doing apples to apples across the board. And if you stick with a standard guideline crosswalk, you’ll be more in tune with what the rest of the people – providers, facilities, or any other entity that you have a relationship with – are doing.”
Perkins' take may be more representative of the healthcare industry at large, at least as of today, but Winkler is not exactly a lone wolf in shunning crosswalks, even if his pack consists mostly of brethren BCBS units. “All the Blues are invited,” to use his approach, he points out. Any takers? “Two of the other plans are using exactly the same solution, the same approach, that we’re taking and so there are others. I can’t say how many, but we know that some are out there."
Tom Sullivan blogs regularly at ICD10Watch.com.
