ICD-10 Coding and GEMs

Tim Buxton, MBA, CPC, CIC, COC, CRC, CCS, CHP

January 11, 2016

The General Equivalence Mappings (GEMs) are a series of crosswalks created by CMS to help all organizations dealing with the ICD-10 transition translate from ICD-9 to ICD-10 quickly and easily.  Unfortunately, many organizations have simply installed the GEMs into their coding or billing systems without understanding the implications of doing so.  This is an invitation for inaccurate coding.

The GEMs cannot be relied upon for complete and accurate coding.  All coders should rely upon the ICD-10 book(s) or an officially certified electronic resource when selecting ICD-10 codes.  Coders should utilize the process they were taught at the beginning of their training: seek the diagnostic terminology in the index, review the tabular for any special notes and to confirm code selection, then assign the code.

There are nearly 70,000 diagnosis codes in ICD-10.  The vast majority of these (over 90%) are different in their specific language than ICD-9 codes.  According to the AAPC, a recent study noted 445 instances when a single ICD-9 code can map to more than 50 possible ICD-10 codes; and 210 instances where a single ICD-9 code can map to more than 100ICD-10 codes (Healthcare Business News, Nov. 2015).  It is impossible for an automated system to accurately and correctly assign ICD-10 codes.

CMS concurs with this recommendation.  In their GEMs FAQ document, the organization notes that, “The GEMs are not a substitute for learning how to use ICD-10-CM and ICD-10-PCS… [I]t will be more efficient and accurate to work from the medical record documentation and then select the appropriate code(s) from the coding book or encoder system.”  (See website below.)

What then is the purpose of the GEMs?  CMS notes that the mappings are intended to assist with converting databases and other technical systems, including DRGs.  That is, the GEMs will help us translate old material into ICD-10 for comparison purposes, but should not be used in lieu of a trained ICD-10 coder for current diagnostic reporting.

For more information on GEMs, please see the CMS FAQ : https://www.cms.gov/medicare/coding/icd10/downloads/gems-crosswalksbasicfaq.pdf

Original Posting:  https://www.episource.com/blog_post/icd10coding_and_gems/

 


Tags: HIX, GEMS, Crosswalk

Log on to Your Rise Account

Forgot your password?
Create an Account

Sponsors

Latest Posts

CMS Gives EDPS Transition Some Breathing Room

CMS published the final call letter for 2018 yesterday, April 3, which included a welcome accouncement regarding the transition from RAPS to EDPS-based RAF scores. Citing numerous public comments on the subject, CMS throttled back the speed with which they plan to switch over to an encounter-based methodology. Instead of the blended rates originally contemplated, they announced that the more modest blend of 85% RAPS to 15% EDPS would be used in 2018, allowing more time to improve the reliability of the encounter data methods. While the RISE data collaboration study was not cited, we believe that the educational value of our study, along with our communication and advocacy of a more moderate approach by CMS, contributed to the confidence with which plans and other interested parties spoke up during the open comment period. Once again, we owe thanks to the folks at Avalere and Inovalon, as well as at AHIP, for the collegial and professional collaboration. Also, we want to thank the health plans that actively participated in our study for making this work possible. ...
Read More

Take Aways from RISE Nashville Summit

The 11th Annual RISE Nashville Summit continued the event’s tradition of yearly growth. The return to downtown Nashville was widely applauded by attendees, who were glad to be back near Broadway’s nighttime funk and fun. While festive, this year's event occurred in the wake of the new administration in Washington, D.C., and the healthcare themes surrounding the "repeal and replace" of the Affordable Care Act (ACA) cast a long shadow. In contrast to the upbeat, confident notes struck by last year’s keynote speaker Senator Tom Daschle, this year’s sobering keynote address by Howard Fineman, NBC/MSNBC political analyst, The Huffington Post Media Group global editorial director, and bestselling author, was an assessment of the pluses and minuses of our new president. Mr. Fineman's remarks indicated that the political alliances in power will seek to undo what Senator Daschle viewed as "irreversible” a year ago....
Read More

Upcoming Conference

 

Qualipalooza: The 2nd Annual RISE Quality Leadership Summit 

This unique event incorporates three conferences presented side-by-side: the Star Ratings Strategic Planning Forum, the HEDIS Forum, and the CAHPS, HOS & Member Survey Forum. Register for one conference for an in-depth examination of a single area, or design your own event by opting for the all-access pass and choosing the sessions from each conference which correspond exactly to your interests.

More

Upcoming Webinar

The Impact of Quality Incentive Models in Medicaid Markets

 

Thirty-one of our fifty states now have Medicaid managed care, and several markets are expected to implement managed care in the next few years. More than $160B in Medicaid spending occurs through the Managed Care Organizations. As more and more states seek to do more with less, increasing accountability for health quality outcomes is placed on health plans. Join this webinar to learn the typical quality payment approaches states use, issues often faced by health plans under each model and what states are expected to do with payment models tied to quality performance in light of near term Medicaid reform efforts.

More

Connect With Us

Copyright © 2014 Resource Initiative & Society for Education. All rights reserved.