Stop Losing to Payers and Focus on Crosswalking

November 30, 2018 by admin0

Hats off to medical billing services because they exhibit crosswalking as part of their work! Crosswalking means translating from one code set to another. The billers/coders compare the old version with the new version of code sets and use only the latest codes to represent diagnostic procedures.

The current version of the International Classification of Diseases (ICD) coding system is ICD-10-CM. Other coding standards used in the process of creating claims are Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCS). Thereupon, using the last released coding format requires deep insights and presence of mind. The more attentive and careful you are the more chances you get in terms of acceptance of claims.


The revision or modification in code sets occurs on a yearly basis. Medical billing experts map obsolete code sets with the updated version of code sets in a medical claim. The process links two distinct code sets, which are identical to each other.

It is important that both the code sets describe the same procedure or treatment. Ordinarily, crosswalking happens between two versions of the same code set. In other words, it is a translation between the latest version and the outdated version of ICD, CPT or HCPCS.

The Real Life Example

The practical example of crosswalking is the translation of ICD-09-CM codes into ICD-10-CM codes. As ICD-09-CM is now outdated and doesn’t represent the correct medical procedures. ICD-10-CM became the official coding structure in October 2015 onwards. The new system carries 68,000 codes roughly while ICD-9 only had 13,000 codes.

Why Crosswalk?

Sometimes, medical coders need to come back and forth between two code sets. For example, when medical billing and coding services have to check a patient’s medical history, they jump from one coding set to another to comply with the coding standard.

The updates in the coding mechanism play along nicely with the advancement in medical science and treatment cycles.

Convert ICD-09-CM into ICD-10-CM

ICD-09-CM was a numeric code set with five characters and some alphanumeric. It had one subcategory and one sub-classification.

Whereas, ICD-10-CM consists of alphanumeric codes, which are seven characters long. It has one subcategory and two sub-classifications. It also has an alpha-extension to describe the visit date and the patient’s illness. It covers more details and, therefore, describes elaborate diagnosis.

The transition between the two code sets is a bit difficult and optimally utilizes the skills of medical coders. It has higher specifications and the organization of codes. Hence, not many codes match with each other in both the coding formats.

American Medical Association (AMA) defined five types of matches in the context below:

1. Exact Matched Codes

In this type of match, codes from both formats match exactly with each other.

2. Approximately One to One Match with One Choice

Codes are not an exact match but have a close resemblance. Around 82.6% of ICD-10-CM codes can be crosswalked back to ICD-09-CM codes because of this type of match.

3. Approximately One to One Match with Multiple Choices

When codes from two different code sets match with multiple choices, it means that they are less specific. The explanation goes like this – A coder may find more than one code in one code set matching with a single code in another code set.

It is up to the coder to choose the most appropriate codes to keep medical claims as accurate as possible.

4. One to Many Matches

As the name suggests, it is a complex type of crosswalk matching. In this type, a single code in one set links to multiple codes in another code set. It means that a single code is crosswalked to a code cluster. A cluster comprises of two-four codes. It is also possible that a source code connects to more than one target cluster of codes.

It is the coder’s job to relate source code to the appropriate cluster. It requires a high level of concentration because a single missing code can cause a denial.

5. Un-Matched Codes

Sometimes, codes of two different code sets don’t match with each other. It happens while crosswalking back from ICD-10-CM to ICS-09-CM. In this scenario, coders use “NoDX” to state that no target code matches with the source code.

How Coders Can Master The Skill?

Modern medical billing can’t survive without excelling in the art of crosswalking. While we create medical claims, it is mandatory to look back in the patient’s medical history. Therefore, to make things manageable, National Center for Health Statistics invented ‘General Equivalency Mappings (GEMs)’ tool.

General Equivalency Mapping Tool

It assists in understanding the basic rules of crosswalking. For instance, you can code a specific injury or disease into a general one but never the opposite.

The tool provides a list of codes and their exact matched, possible matched, or appropriate matched codes from the other set. However, it is crucial for the coder to have medical billing and coding knowledge before using the tool.

The Way Forward in Medical Billing

Physicians’ reimbursements depend upon the accuracy of medical claims. If the claims contain errors and incorrect information, insurance companies will not pay against them until you remove those mistakes. That is exactly where P3 Healthcare Solutions comes in and gives crosswalking a new name. Follow us on LinkedIn for more information on coding mechanisms and changing healthcare industry.


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Copyright by P3 Care Healthcare Solution 2018. All rights reserved.

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