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by Michael Alan Meyer, DO, CCS, CPC, CPCI, AHIMA ICD-10-CM/PCS Trainer and Ambassador
In last week’s article, we looked at the new features in ICD-10-CM that are not in ICD-9-CM. Click on this link for the ANSWER to last week’s Challenge Question on the new code structure!
General Equivalence Mappings (GEMs)
Medical code conversion mapping is not an exact science. It is an attempt to translate equivalent meaning from source code to target code, e.g., converting ICD-9 CM to ICD-10 CM or ICD-10 CM to ICD-9 CM. Mapping success is driven by the purpose of the mapping, e.g., if it is being done for high level data analyses for coded data integrity and continuity for medical research, medical reimbursement analyses, or case rate reporting for morbidity and mortality. These are all examples of appropriate GEM use. However, mapping codes should not be done for the purpose of coding a patient record. This is why your software vendors will not be programming automated conversions of your patient diagnoses (and procedure data for facilities) within your medical billing software.
This week’s presentation explains why providers and coders must only code from the patient record, using their code reference books and not from a GEM conversion table or software tool in order to avoid errors in coding, billing and potential fraud.
To learn more see the attached ICD-10-CM presentation: GEMS; Genuine Diamonds or Cubic Zirconium?
This week’s Challenge Question #4 GEMS!
___________
References:
CDC, (2012) National Center for Health Statistics. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) http://www.cdc.gov/nchs/icd/icd10cm.htm
CMS, (2012) ICD-10 CM: https://www.cms.gov/ICD10/11b1_2011_ICD10CM_and_GEMs.asp
WHO (2012) Main content The WHO Family of International Classifications. http://www.who.int/classifications/en/
In last week’s article, we looked at the new features in ICD-10-CM that are not in ICD-9-CM. Click on this link for the ANSWER to last week’s Challenge Question on the new code structure!
General Equivalence Mappings (GEMs)
Medical code conversion mapping is not an exact science. It is an attempt to translate equivalent meaning from source code to target code, e.g., converting ICD-9 CM to ICD-10 CM or ICD-10 CM to ICD-9 CM. Mapping success is driven by the purpose of the mapping, e.g., if it is being done for high level data analyses for coded data integrity and continuity for medical research, medical reimbursement analyses, or case rate reporting for morbidity and mortality. These are all examples of appropriate GEM use. However, mapping codes should not be done for the purpose of coding a patient record. This is why your software vendors will not be programming automated conversions of your patient diagnoses (and procedure data for facilities) within your medical billing software.
This week’s presentation explains why providers and coders must only code from the patient record, using their code reference books and not from a GEM conversion table or software tool in order to avoid errors in coding, billing and potential fraud.
To learn more see the attached ICD-10-CM presentation: GEMS; Genuine Diamonds or Cubic Zirconium?
This week’s Challenge Question #4 GEMS!
___________
References:
CDC, (2012) National Center for Health Statistics. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) http://www.cdc.gov/nchs/icd/icd10cm.htm
CMS, (2012) ICD-10 CM: https://www.cms.gov/ICD10/11b1_2011_ICD10CM_and_GEMs.asp
WHO (2012) Main content The WHO Family of International Classifications. http://www.who.int/classifications/en/
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