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The GEMs are a tool that you can use to convert data from ICD-9-CM to ICD-10-CM and ICD-10-PCS and vice versa. Medisoft 19, Medisoft 20, Lytec 2014 and Lytec 2015 mapping utility uitlized the GEM tool. The GEMs are also known as crosswalks as they provide important information linking codes of one system with codes in the other system. The GEMs are a comprehensive translation dictionary that can be used to accurately and effectively translate any ICD-9-CM-based data, including data for:
Tracking quality, Recording morbidity/mortality, Calculating reimbursement, or
Converting any ICD-9-CM-based application to ICD-10.Mapping from ICD-10-CM and ICD-10-PCS codes back to ICD-9 codes is known as backward mapping. Mapping from ICD-9 codes to ICD-10 and ICD-10 codes is known as forward mapping. The GEMs are complete in their description of all the mapping possibilities as well as when there are new concepts in ICD-10 that are not found in ICD-9. All ICD-9 codes and all ICD-10 codes are included in the collective GEMs:
All ICD-10 codes are in the ICD-10-CM to ICD-9 GEMs.
All ICD-9 diagnosis codes are in the ICD-9 to ICD-10 GEMs.
All ICD-10 codes are in the ICD-10-PCS to ICD-9 GEMs.
All ICD-9-CM procedure codes are in the ICD-9-CM to ICD-10-PCS GEMs.
Who can use the GEMs? Were the GEMs designed for use by all providers and payers/insurance or was the focus on use with Medicare only?
The GEMs were designed as a general purpose translation tool that can be used by anyone who wants to convert coded data. Possible users of the GEMs include:
All payers, All providers, Medical researchers, Informatics professionals, Coding professionals–to convert large data sets, Software vendors–to use within their own products such as Medisoft, Lytec and Greenway Prime Suite.What process was used to develop the GEMs? Did CMS and CDC seek input from organizations such as the American Hospital Association (AHA) and the American Health Information Management Association (AHIMA) on the development of the GEMs? Did development of the GEMs involve both clinical and coding evaluations?
The GEMs were developed over a period of 3 years by CMS and CDC, with input from both AHA and AHIMA. The GEMs development and maintenance team includes clinicians, coding experts, representatives of the Cooperating Parties (CMS, CDC, AHA, and AHIMA), and the team that developed and maintains ICD-10-PCS. The Cooperating Parties collaboratively write the “Documentation and User’s Guides,” which are updated and posted annually along with the other ICD-10-CM, ICD-10-PCS, and GEMs files.
Are the GEMs a substitute for learning to use ICD-10-CM and ICD-10-PCS?
The GEMs are not a substitute for learning how to use ICD-10-CM and ICD-10-PCS. Providers’ coding staff will assign codes describing patients’ encounters from the ICD-10-CM and ICD-10-PCS code books or encoder systems. In coding individual claims, it 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. The GEMs are a tool to assist with converting larger ICD-9-CM databases to ICD-10-CM and ICD-10-PCS.
How have the GEMs been used to date?
To date, the GEMs have been used to:
Translate ICD-9-CM codes in the “Official ICD-9-CM Coding Guidelines” to aid in producing the “ICD-10-CM Official Guidelines for Coding and Reporting”; Convert Medicare Severity Diagnosis-Related Groups (MS-DRGs) from an ICD-9-CM-based application to an ICD-10 based application;
Convert the Medicare Code Editor to a native ICD-10 based application and Produce a purpose-built ICD-10 to ICD-9 crosswalk for reimbursement called the “ICD-10 Reimbursement Mappings.”Are there any instances where there is no translation between an ICD-9-CM code and an ICD-10 code? How do the GEMs handle this situation?
Yes, there are instances where there is no translation between an ICD-9-CM code and an ICD-10 code. The “No Map” flag indicates that there is no plausible translation from a code in one system to any code in the other system. For example, the following codes are marked with the “No Map” flag: ICD-10-CM code Y71.3 – Surgical instruments, materials and cardiovascular devices (including sutures) associated with adverse incidents,
which has no reasonable translation in ICD-9-CM and ICD-9-CM procedure code 89.8 – Autopsy, which has no reasonable translation in ICD-10.Why do the GEMs go in both directions from ICD-9 to ICD-10 and from ICD-10 back to ICD-9?
The GEMs are designed to be used like a bi-directional translation dictionary. They go in both directions so that you can look up a code to find out what it means according to the concepts and structure used by the other coding system. The bi-directionality is similar to how Spanish-English and English- Spanish dictionaries are designed. Neither the two dictionaries nor the GEMs are a mirror image of each other. Because the translation alternatives are based on the meaning of the code you are looking up (which includes tabular instruction, index entries, guidelines, and applicable Coding Clinic advice), the ICD-10 to ICD-9 GEMs are not a mirror image of the ICD-9 to ICD-10 GEMs.
The GEMs were designed to convert current ICD-9-CM codes to applicable ICD-10 codes. You can use a reverse lookup of the backward mappings (ICD-10 to ICD-9 GEMs, looked up by ICD-9 code) to convert payment logic or coverage decisions from ICD-9 codes to ICD-10 codes. You could also use this mapping (ICD-10 to ICD-9 GEMs) to examine trend data over multiple years, spanning the implementation of ICD-10. For example, in 2015, you will be able to compare how frequencies changed for a specific condition using an ICD-10 code compared to prior years using ICD-9-CM codes. You can use the forward mapping (ICD-9-CM to ICD-10-CM/PCS GEMs) to convert ICD-9-CM-based edits. You can also use the forward mapping for any analysis or conversion project that needs to examine ICD-10 codes and to determine the ICD-9-CM code(s) that previously captured this diagnosis or procedure.
We were told that validation of the GEMs is occurring as part of the conversion of the current ICD-9-CM-based MS-DRGs to ICD-10-based MS-DRGs. How does this process identify any potential updates that might be needed to the GEMs? Will the GEMs be updated to correct any inaccuracies discovered in this process?
Because the process of MS-DRG conversion began with an initial translation using the ICD-10 to ICD-9-CM GEMs and then used the ICD-9-CM to
ICD-10 GEMs to identify any additional conversion issues, all four GEMs were tested in the initial conversion process. Any inaccuracies discovered in the process were immediately noted so that changes were made to the affected GEMs and included in the next annual update. The updated GEMs are posted annually along with the annual code updates to ICD-10-CM and ICD-10-PCS at http://www.cms.gov/Medicare/Coding/ICD10/index.html on the CMS website.How soon after a code has been added or deleted will the GEMs be updated to
reflect these changes?They update ICD-9-CM and ICD-10 codes each year. A post updates to the GEMs annually to reflect these updates and will continue to update the codes and GEMs on an annual basis for a minimum of 3 years after ICD-10 is implemented on October 1, 2015.
Why do we need the GEMs?
We need the GEMs because:
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.
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