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Both, ICD-10 is much more specific:
• For diagnoses, there were 14,567 ICD-9-CM codes and 69,832 ICD-10-CM codes.
• For procedures, there were 3,882 ICD-9-CM codes and 71,924 ICD-10-PCS codes (in the 2015 versions of ICD-9-CM, ICD-10-CM, and
ICD-10-PCS).One ICD-9-CM diagnosis code is represented by multiple ICD-10-CM codes:
• 82002 Fracture of midcervical section of femur, closed:
From S72031A Displaced midcervical fracture of right femur, initial encounter for closed fracture; delayed healing; – From S72032A Displaced midcervical fracture of left femur, initial encounter for closed fracture and other codes from the GEMs.
One ICD-10-CM diagnosis code is represented by multiple ICD-9-CM codes:
• E11341 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema: • To ICD-9 cluster:
– 25050 – 36206 – 36207
Diabetes with ophthalmic manifestations, type II or specified type, not stated as uncontrolled; Severe nonproliferative diabetic retinopathy;
Diabetic macular edema;
A few ICD-10-CM codes have no predecessor ICD-9-CM codes:
• T500x6A
• T501x6A
• T502x6A
• T503x6A
• T504x6A
• And others found in the GEMs; and
Underdosing of mineralocorticoids and their antagonists, initial encounter;
Underdosing of loop [high-ceiling] diuretics, initial encounter;
Underdosing of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, initial encounter; Underdosing of electrolytic, caloric and water-balance agents, initial encounter;
Underdosing of drugs affecting uric acid metabolism, initial encounter;
One ICD-9-CM procedure code is captured by multiple ICD-10-PCS codes: • 8659 Suture of Skin and Subcutaneous Tissue of Other Sites:
– To 0JQ10ZZ
– To 0JQ13ZZ
– To 0JQ40ZZ
– To 0JQ43ZZ
– And others found in the GEMs.
How are the GEMs files formatted?
Below is an example from the ICD-10-CM diagnosis mapping:
ICD-10-CM Source system code is on the left side;
ICD-9-CM Target system code is in the middle; and
Flags are on the right:
Repair Face Subcutaneous Tissue and Fascia, Open Approach;
Repair Face Subcutaneous Tissue and Fascia, Percutaneous Approach;
Repair Anterior Neck Subcutaneous Tissue and Fascia, Open Approach;
Repair Anterior Neck Subcutaneous Tissue and Fascia, Percutaneous Approach;
ICD-10-CM Source Code ICD-9-CM Target Code Flags
T1500xA 9300 10111
T1500xA E914 10112
T1500xS 9085 10000 T1500xA Foreign body in cornea, unspecified eye, initial encounter: • To ICD-9 cluster:
– 9300 Corneal foreign body;
– E914 Foreign body accidentally entering eye and adnexa. T1500xS Foreign body in cornea, unspecified eye, sequela: • To 9085 Late effect of foreign body in orifice.
The flags are read as:
1 = On; and
0 = Off.
There are three different flags:
“Approximate” is Flag 1, which is in column 1 of the flags:
• 1 means the translation is an Approximate match:
– The majority of alternatives are considered an Approximate match;
• 0 means the translation is an Identical match: – Rare in the procedure GEMs;
– More common in the diagnosis GEMs;
• Example of diagnosis Approximate match (1), not Identical match: – T1500xA 9300 10111;
– T1500xA E914 10112;
– Each of these codes is an Approximate match;
• Example of diagnosis Identical match (0):
– 41411 I2542 00000;
– ICD-9-CM code 414.11 is an Identical match to ICD-10-CM code I2542;
“No Map” is Flag 2, which is in column 2 of the flags:
• 1 means there is no plausible translation for the source system code;
• 0 means there is at least one plausible translation for the source system code;
• Notice the NODX “No Description Found” entry instead of a code number in middle column:
T500x6A NODX 11000 T500x6D NODX 11000 T500x6S NODX 11000
– T500x6A
– To NODX
– T500x6D
– To NODX
Underdosing of mineralocorticoids and their antagonists, initial encounter: No description found.
Underdosing of mineralocorticoids and their antagonists, subsequent encounter: No description found.

– T500x6S Underdosing of mineralocorticoids and their antagonists, sequela:
– To NODX No description found; and
“Combination” – Flag 3, which are the scenario and choice list flags:
• 1 means code maps to more than one code;
• 0 means the code maps to a single code;
• Flags 4 and 5 further clarify combination entries (refer to the “Documentation and User’s Guides” for complete information on these flags):
ICD-10-CM Source Code
T1500xA T1500xA T1500xS
ICD-9-CM Target Code
9300 E914 9085
Flags 10111 10112 10000
– T1500xA Foreign body in cornea, unspecified eye, initial encounter: – To ICD-9 cluster (Flag 3 is 1):
– 9300 Corneal foreign body;
– E914 Foreign body accidentally entering eye and adnexa.
– T1500xS Foreign body in cornea, unspecified eye, sequela (Flag 3 is 0): – To 9085 Late effect of foreign body in orifice.
Is there a one-to-one match between ICD-9-CM and ICD-10?
No, there is not a one-to-one match between ICD-9-CM and ICD-10, and the reasons for such include: There are new concepts in ICD-10 that are not present in ICD-9-CM;
For a small number of codes, there is no matching code in the GEMs;
There may be multiple ICD-9-CM codes for a single ICD-10 code; and
There may be multiple ICD-10 codes for a single ICD-9-CM code.
Are there instances when it is not necessary to use the GEMs?
In the following instances, it may not be necessary to use the GEMs:
When a small number of ICD-9-CM codes are being converted to ICD-10-CM and ICD-10-PCS codes,
it may be quicker, easier, and more accurate to simply look up the codes in an ICD-10-CM or
ICD-10-PCS code book; and
When ICD-10-CM/PCS is implemented on October 1, 2015, coders will use coding books or encoder
systems to code rather than using the GEMs.
Sources of information: https://www.cms.gov/medicare/coding/icd10/downloads/gems-crosswalksbasicfaq.pdf
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