Bringing ICD-10 to the Masses

It's finally here. After numerous delays and false starts, the US has made ICD-10 the law of the land. We'll have a more complete picture of how the health care system is doing after the first billing cycle finishes in a couple of weeks. You can (must!) get started today, and we've built APIs to help you do just that. And along with the major news we announced today (eliminating X12 transaction fees!), these new APIs will help you submit claims confidently.

Convert ICD-9 Codes
We're starting with two new APIs. The first one, /icd/convert/:code, allows you to supply ICD-9 codes and get back an exact match, based on CDC guidelines. If an exact mapping isn't available, you'll get back the closest matches, along with the constraints that you'll need to map. Let's look at an example, converting 0010, "Botulism food poisoning".

Here we can see that it is an approximate conversion, which means the mapping between the codesets is inexact. The "combination" field indicates whether one ICD-10 code or many is necessary to represent the same information. The mapping from ICD-9 to ICD-10 isn't a one-to-one mapping, so the way to choose the proper codes from ICD-10 is a little tricky, but PokitDok is here to help. Each result payload has a list of scenarios to choose from, and exactly one must be chosen. For that chosen scenario, you should select only one item from every choice_list in the scenario. These selected codes will represent the original code.

Convert ICD-9 Claims

Even better than converting codes, we've developed an endpoint - /claims/convert that accepts ICD-9 claims and then up-converts them to ICD-10, returning the whole 837 claim. You can use the returned data for review or validation. Then when you're satisfied, submit it for processing to our API. (Remember, no more transaction fees!)

And as a bonus - and this is huge - not only do we give you back your claim with the codes converted, but we also convert the claim into PokitDok JSON format. So you go from ugly:

To pretty:

Which do you think looks easier to implement?

These new API endpoints should help ease the transition to the new standard. Soon enough, you'll be able to code Z62.891 "Sibling Rivalry". Real-time conversion and crosswalk with your claims data, available today, and a migration path to a vastly superior way of submitting claims. Pretty good for a Tuesday.

Take a look at our documentation and start converting.

About Ghadi Shayban

I work on backend data engineering at PokitDok, and I'm passionate about bringing health care informatics a couple decades forward. If I were stranded on a desert island and had a laptop, I'd open up Emacs and a Clojure REPL. When not on a computer keyboard, I can be found on a piano keyboard, playing around Charleston, SC.

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