“Unified ICD Services (UIS)” brings custom built clinical intelligence for doctors to determine correct ICD-10 diagnosis, surgical codes with faster and smarter approach. UIS additional features would provide more specific data up front to doctors/physicians to less follow-up and fewer denials after claims submission”.

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Abstract Title:Visual tool thatwouldassistdoctorsindeterminingthe correctICD-10 codeseasily
[OR]
Unified ICD Services (UIS)
Overviewof Project(200-500 words): icd
Introduction: ICD-10 CM/PCS (International Classification of Diseases, 10th Edition, Clinical
Modification/ Procedure Coding System) is the new generation of diagnosis and facility procedure
coding (PCS) developed by the CMS for use in all U.S. health care settings. The ICD-10-CM is based on
the ICD-10, the statistical classification of disease published by the World Health Organization (WHO).
WHO has authorized the development of an adaptation of ICD-10 for use in the United States for U.S.
government purposes. As agreed, all modifications to the ICD-10-CMmust conform to WHO conventions
for the ICD-10.
Overview:
“Unified ICD Services (UIS)” brings custom built clinical intelligence for doctors to determine
correct ICD-10 diagnosis, surgical codes withfaster and smarter approach. UIS additional features would
provide more specific data up front to doctors/physicians to less follow-up and fewer denials after
claimssubmission”.
ExistingSystem:
 We have few number of web tools to get ICD-10 details but those do not provide additional
features like lab results to clinical code conversion, build a code, estimate reimbursement
amountperformedforcodes.
 Most of themare licensed services andusershave topay forthe service.
 We don’thave extendable unifiedtool whichincorporatesall ICDrelatedservices.
ProposedSystem:
Heavy WeightUIS:
 The clientiscomputerbasedbrowsers andsmartphone baseddesktopbrowsers.
 Have our own ICD 10 database where data get loaded from CMS published site and additionally
providingUIwizardsto dovarious operationsoverICD-10data.
 In built smart search tool which translate clinical terms to coding terms with synonyms accepted
by Medicaid/Medicare system. It makes use of the autocomplete feature, search by ICD-10 code
number, and code view by alphabetic index and tabular index, drill-down tree navigation
system, symptomsbasedsearch, bodypartsand correspondingcode search.
 In builtICD-10 code builderto buildICD10 code basedondescription.
 Custom built cost lookup tool to view actual cost to perform a particular code, expected cost
from Medicaid/Medicare/other insurance, actual cost given by payers for the code. Addition to
thisusercan see the cost trendfor each code.
 In built GEM tool to convert to and from ICD-9 and ICD-10 codes. Additions to this expose
service (ICDDeterminer) todetermine whetherthe passingcode isICD-9or ICD-10.
 Lab resultsto clinical code tool whichwouldsuggestapplicablecodesbasedonlabresults.This
will provide workingsetof diagnosestobillingprocess.Alsousercanassociate diagnosiscode to
surgical code.
 ClaimDeny Preventerisadditional tool whichwouldhelpdoctors/physicianstoavoidfurther
denial frompayer.
 Providing flexibility to integrate with any EMR (Electronic Medical Record) software through ESB/SOA

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basedapproach.
Light WeightUIS– Mobile Version:
 The clientissmart phone based mobile browsers.
 Notall the serviceshave beenexposed andprovidingbasic“searchbyICD-10 code number”.
Deployment Scenarios: The proposed application features are common to all doctors/physicians and
hence planningtoanalyze the below feasibilities.
1st
. Deploy application in cloud based, “Platform as a service (Paas)” either Oracle Cloud or
Google AppEngine or Salesforce toreduce middleware maintenance cost.
2nd
Enable application as cloud based “Software as a service (SaaS)” which would support
multitenant users. So doctor/physician no needs to bother about setting up application,
setting up infrastructure. Hence in this case deployment scenario is either separate
application-DB per subscriber, or single application with multiple DB for all subscribers, or
single applicationwithsharedDBforall the subscribers.
For more detailsinformationplease referPOCsection.
Value to HealthCare payer application:
1) Dual processing claims engine: HealthCare payer application would support ICD-9 and ICD-10 claims
based on date of services. System will deny the ICD-9 claims after a certain period. Beyond that
HealthCare payerapplication wouldsupportonlyICD-10claims.
If HealthCare payer application is ICD-10 enabled and incoming claim is ofICD-09, we can extend
proposed system GEM tool to convert incoming ICD-9 code to ICD-10 code and let pass through the
adjudication. Thiswillallow backwardcompatibility.
E.g. Let assume after March-2014 HealthCare payer application would not support ICD-9 claims, but the
external provider system would support only ICD-9 until Jul-2014 due to some migration issue. If that
providersubmittingsome claimsonMarch-2014 HealthCare payerapplication willdenythe claim.
Instead of denying the claim, let adjudicate the claim with GEM ICD-9 conversion tool and send back
the amount payable details. If the provider accepts the lesser amount due to ICD-9 let pay the amount
otherwise deny the claim. Why we have to restrict HealthCare payer application and extend this support
until otherhealthsystemsmigrate toICD-10.
2) To avoid double billing: HealthCare payer application didn’t have functionality to validate whether
the incomingclaimhave combinationof ICD-9andICD-10 codes.
E.g. Assume by mistakenly provider sending a claim with ICD-9 (Code: 001) and ICD-10(Code: A00). Both
codes have identical disease name. In such a case we have to deny the claim as duplicate, but the
current HealthCare payer application will pay for two codes. This can be avoided by use of proposed
“ICD Determiner”service.
Descriptionof Proof of Concept(whatwill itdemonstrate?):
Functional Specification:
1. ICD-10 Data Load/Setup:
 All ICD-10-CM and Icd-10-PCS code sets are available in CMS site in XML format. We can either
parse usingjavatechnologies [OR] directlydump XMLintoDB isyet todecide.

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 User can add newICD code,delete andupdate the existingICDcode.
2. ICD Smart Search:
A. Autocomplete/Fast search - Results start displaying as you type in your search entry. This allows
for a fast search, user don’t have to finish typing keyword and there are no further clicks
involvedorpagestoload.
B. Searchby ICD-10 code number- Justhave to enterthe code number - itevenworkswithpartial
code searches.Forexample,if userenterthe ICD-10-CMcode "I13" in the searchfiled, userwill
be presentedwithalistof fourconditionsthatstart withthatcode number:
I13.0 - Hypertensive heartandrenal disease with(congestive)heartfailure
I13.1 - Hypertensive heartandrenal disease withrenal failure
I13.2 - Hypertensive heartandrenal disease withboth heartfailure andrenal failure
I13.9 - Hypertensive heartandrenal disease,unspecified
C. Code viewbyalphabeticindex and tabularindex- Listof alphabets usedthroughoutascreen
listedinorderor intabularorder, will helpthe readerfindinformationquickly.
D. Drill-down tree navigation system – It presents a hierarchical view of ICD codes. Each item (often
called a branch or a node) can have a number of sub groups. An item can be expanded to reveal
subgroup, if anyexist,andcollapsedtohide sub group.
E. Symptoms based search – Just have to enter the symptom. For example, if user enters
“Typhoid” in the search field, then user will be presented with a list of Typhoid related codes. In
Add/Update screenwill have “Symptoms”textbox toadd/update valuesforthe particularcode.
F. Bodyparts basedsearch - List outbody parts and associatedcodes. .In Add/Update screenwill
have “Body Part” textbox to add/update values forthe particularcode.
3.ICD Code Builder:
 Step by step approach to build a code using detail description. Just user have to select
descriptionineachstepandfinallyappropriatecode willgetgenerate.
4. ICD Cost Lookup:
 Each code has approximate cost spend, expected cost from payer and actual cost paid by payer.
Authorized user can view the fee scheduled for each code. Also this can be viewed in code
Suggester. In Add/Update screen will have “Fees and Unit” text boxes to add/update values for
the particularcode.
 Cost trend analysis report will give overall ROI for the codes based on actual cost and payer paid
cost fromhistorydata.
5. ICD GEM Mapper:
 The GEM Mapper is used to convert data from ICD-9-CMto ICD-10-CMand ICD-10-PCS and vice
versa. The GEMs are also known as crosswalks as they provide important information linking

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codes of one system with codes in the other system. The GEMs are a comprehensive translation
dictionarythatcan be usedtoaccuratelyand effectivelytranslate anyICD-9-CM-baseddata.
6. ICD Determiner:
 The service whichwill determine whetherthe passingcode isICD-9or ICD-10.
7. ICD Code Suggester:
 A code Suggester or lab result to clinical code tool is one of the main features of UIS. Based on
patient lab results this would list out applicable ICD code. User can select appropriate code for
billingprocess ortoapplyclaims.
8. ICD ClaimDenyPreventer:
 It’s a kind of note tool where doctor/physician can log deny claim details for the particular code.
To avoiddenial atfuture thiswouldhelptoapplyrightcode forright combination.
Technical Specification:
1. Please referbelowarchitectureoverview section.
2. Data modelingstructure notdecidedyet.
Primary Contact Information: RajasekaranKandhasamy

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Architecture Overview:
Presentation Tire
Business/Service
Tire
Integration Tire
Services Data Transfer
Objects
EAI Layer DAO Layer
Computer Browsers Smart Phone Browsers
Service Layer Delegates
CostLookupHandl
er
SearchHandlerAddCodeHandler
GEMHandler
CodeBuildHandler
CodeSuggestHand
er
Mobile Components
JSPs
Spring EnabledLayer
AddCodeService
SearchService
CodeBuildService
CostLookupService
GEMService
CodeSuggestService
AddCodeDTO
SearchDTO
CodeBuildDTO
CostLookupDTO
GEMDTO
CodeSuggestDTO
JAXB -XMLParsers XMLDbDAO
AddCodeDAO SearchDAO
CodeBuildDAO CostLookupDAO
SuggesterDAO
Web Service to Integrate
with External Systems
Web Service to Get ICD
DetailsFrom Other Site