Are all SNOMED CT and ICD-10-CM codes included in the Map?

• The direction of the Map is from SNOMED CT (source) to ICD-10-CM (target). All pre-coordinated SNOMED CT concepts that are appropriate for use in a problem list (about a third of all active SNOMED CT concepts) are potentially within scope for the map. Initially, a smaller subset of frequently used SNOMED CT concepts will be mapped. Not all ICD-10-CM codes will appear as targets. It is expected that frequently occurring ICD-10-CM codes will be covered in the initial phase. This can only be verified when real-life usage statistics of ICD-10-CM codes are available. Because of the difference in granularity of the two terminologies, some ICD-10-CM codes will not have SNOMED CT correspondents (e.g. concepts with laterality or episode of care information). Full representation of these ICD-10-CM codes will require post-coordination in SNOMED CT, which is not included in this Map.

Can the Map be used to automatically generate ICD-10-CM codes?

• The Map is intended to be used in a semi-automatic manner. The Map will suggest candidate ICD-10-CM codes based on SNOMED CT codes and, if applicable, additional information obtained from the electronic patient record or direct user input. Review of the candidate ICD-10-CM codes by either the healthcare provider or professional coder is recommended. The Map contains map rules and advice that can be used to highlight specific coding principles, or point to additional information required for coding. For the simple cases with one-to-one mappings, it is likely that a high proportion of the candidate ICD-10-CM codes will be adopted by the reviewer.

Is the order of the ICD-10-CM codes important?

• When a single SNOMED CT concept generates a combination of ICD-10-CM codes, the order of the ICD-10-CM codes complies with ICD-10-CM coding guidelines. For example, in a ‘dagger-and-asterisk’ (etiology and manifestation) code combination, the etiology code will be in Map group 1 and the manifestation code Map group 2. For injury or poisoning cases, the clinical condition code will be in Map group 1 and the external cause/poisoning code Map group 2. However, when a patient has multiple SNOMED CT-coded problems for a single encounter, each mapping to a different ICD-10-CM code, the Map does not include information to determine the order in which the ICD-10-CM codes should be submitted e.g. as primary or secondary diagnosis.

Are all ICD-10-CM codes in the Map authorized for reimbursement?

• Not necessarily. In planning for the development of this map, advice was sought from the Center for Medicare and Medicaid Services (CMS) regarding ICD-10-CM code restrictions for reimbursement in the US. Due to regional variations in care profiles and carrier procedures for authorization of reimbursement, no authoritative resource could be identified to guide target code selection beyond those published by National Center for Health Statistics (NCHS).

Are the ICD-10-CM codes optimized for reimbursement?

• No. The mappings are created to accurately reflect the meaning of the SNOMED CT concept. The level of reimbursement is not considered.

Last Reviewed: February 29, 2012