Timeline to ICD-10: BCBS Michigan Approach is Business-Driven

Thursday, January 19th, 2012
This post was written by Patricia Donovan

In its third year of ICD-10 work, BCBS of Michigan sees the project as business-driven, not solely an IT initiative. Early on, the Blues plan realized the ICD-10 transition affected nearly all aspects of its business, explained Dennis Winkler, BCBSM’s ICD-10 technical program director, in this week’s webinar on Mapping the Way to ICD-10 Readiness.

One of the first steps in the project was determining how and where it was using codes, Winkler continued. The challenge was then determining how to associate or map ICD-10 diagnosis codes to the proper diagnostic category, and then validate the mappings for professional claims. Faced with more than 70,000 ICD-10 codes, BCBSM focused its work on codes with discrepancies and high-impact codes.

After identifying discrepancies — when an ICD-10 code points to more than one ICD-9 category — BCBSM enlisted five ICD-10-certified coders and a legion of doctors and nurses to help resolve code discrepancies.

The result of their efforts was “BCBSM Blue GEMs” — the payor’s own customized database of general equivalence mappings (GEMs) whose life span would end when CMS stops updating GEMS. The company is willing to share BCBS Blue GEMS with interested entities who wish to model its approach, provided a formal request is submitted.

The BCBSM Blue GEMS will be loaded into an ICD-10 encyclopedia, an enterprise-wide tool that will become “the single source of truth” on ICD-10 as well as a baseline for annual updates, Winkler said.

Winkler also predicted that the issue of ICD-10 neutrality — which occurs when neither the claims acceptance rate, the number or rate of inquiries, the rate of electronic claims or claims reimbursement amounts are affected — will continue to be a hot topic for 2012. Winkler defined the four challenges of neutrality as well as its six targeted dimensions, emphasizing that BCBSM has a reliable process for each of these six dimensions.

A successful transition to ICD-10 will require different levels of collaboration from payers, providers, medical societies and state agencies to get the job done, followed by “testing, testing and more testing.”

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