Insulating legacy systems

In some cases, you as a HIPAA participant, might want to temporarily insulate your legacy systems from the impact of the ICD-10 changes. In such situations, you must accept HIPAA 5010 transactions with ICD-10 codes and then exchange them for ICD-9 codes that your system understands.

Such a process typically includes parsing of the HIPAA EDI data to isolate the ICD-10 codes, communicating the codes to be cross walked to the rules/cross walking engine, converting the codes based on pre-defined criteria, using the cross walked codes in legacy systems, and tracking the changes made to the codes for audit and historic reporting. This example demonstrates a small portion of such a system. The Transformation Extender processes incoming HIPAA EDI data and communicates with a rules engine such as "IBM ILOG JRules", using an XML file, and sends the rules engine a structure containing the codes that need to be cross walked.

In this scenario, the rules engine (not included) performs the actual cross walk and returns a structure that contains both the original ICD-10 codes and the replacement ICD-9 codes. The resulting XML structure is then used by the Transformation Extender Platform to replace the codes in the original HIPAA EDI data.

It should be noted that this example is a black box inside of a black box. It does not show the orchestration of the various components. An orchestration tool, such as Business Process Management, would call the various transformation and cross walking components, and coordinate their efforts. Also, the rules engine is treated as a black box. In the example, one set of cross walked test data is shown. There is no functioning rules engine in the example. This example is not intended to be used as a confirmation of the cross walking done, as the testcase is fictitious.

The process behind this specific example is to map ICD-10 codes from a HIPAA 837 professional claim transaction (837P) into an XML format described by a schema. The XML instance document generated by the Transformation Extender Platform, is expected as input into a rules engine. A simulated modified XML instance document that contains both the ICD-10 codes as well as the equivalent ICD-9 codes is returned to Transformation Extender where that information is used to replace the ICD-10 codes in the original claim transaction. This cross walking usually occurs during the process of a real transformation, for example, a transformation between the HIPAA EDI and a proprietary format. For the sake of simplicity the transformation in this example does not reformat the data, it simply includes the new codes. A true cross walking service would do much more than take one code and map it to another, it could have intelligence to handle one code in, many codes out, multiple codes in, one code out, or exception cases where human process flows should be initialized.