ICD 10 Reimbursement mapping

What are the Reimbursement Mappings?

The Reimbursement Mappings were developed by CMS in response to non-Medicare industry requests for a “standard one-to-one reimbursement crosswalk,” which is a temporary mechanism for mapping ICD-10-CM/PCS codes submitted on or after October 1, 2013 back to “reimbursement equivalent” ICD-9-CM codes. In order to develop the Reimbursement Mappings, CMS used the GEMs as a starting point by selecting the best ICD-9-CM code that maps to each ICD-10 code based on Medicare data. The Reimbursement Mappings identify the best matching ICD-9-CM code that can be used for reimbursement purposes for each ICD-10 code. All ICD-10-CM/PCS codes are in the Reimbursement Mappings; however, all ICD-9-CM codes are not in the Reimbursement Mappings. Where an ICD-10-CM/PCS code
translates to more than one ICD-9-CM code, a single choice is required to create a functioning crosswalk. Inpatient hospital frequency data was used to aid in choosing a final ICD-9-CM translation in the crosswalk. If needed, the Reimbursement Mappings may be used to process ICD-10-CM/PCS-based claims received on or after October 1, 2013, with a legacy ICD-9-CM-based system as part of a planned transition period, until systems and processes are developed to process ICD-10-CM/PCS-based claims directly. The Reimbursement Mappings consist of two crosswalks:

*  ICD-10-CM to ICD-9-CM for Diagnosis Codes; and
*  ICD-10-PCS to ICD-9-CM for Procedure Codes.

CMS is not using the ICD-10 Reimbursement Mappings for any purpose. We are converting our systems and applications to accept ICD-10-CM/PCS codes directly.

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