In preparation for the upcoming change to the ICD-10 diagnosis coding format on October 1 2014, General Equivalence Mapping tools, known as GEMS, were created. These tools were created to assist coding professionals, providers, payers, medical researchers, and software vendors, among others, to convert ICD-9 codes to the new ICD-10 format. Different GEMS have been created by organizations such as Centers for Medicare and Medicaid Services (CMS), the National Center for Health Statistics (NCHS), the American Hospital Association (AHA), and 3M Health Information Services. There are many available.
GEMs will be a great resource. They will allow easy look up of ICD-10 codes, and most will be updated automatically as changes to the code set are made. They offer mapping from ICD-9 to ICD-10 (known as forward mapping) and mapping from ICD-10 back to ICD-9 (known as backward mapping). However, along with the advantages of using GEMs mapping tools, provider’s offices must be aware of their limitations. This knowledge will allow users to enjoy the benefits of a GEMs tool, but be aware of the disadvantages as well.
First and foremost, GEMs were not designed for coding. Instead, they were created as a tool to test and convert large ICD-9 systems to ICD-10, develop application specific-mappings, and link and analyze data in long-term clinical studies. They are a starting point only, a tool or resource. They are not a coding tool and should not be used as a substitute for an ICD-10 code book, and ICD-10 training.
Since GEMs tools have been created by many entities, they all have different programming and logic. Therefore, if you input the same ICD-9 code into several different GEMs softwares, you can get different ICD-10 codes outputs from each GEMs software. Depending on the built in logic of the program you are using, you can get different suggested codes than another program may offer. When you purchase a GEMs tool, it will be important to understand the logic it uses so you will understand what output you will receive. Training on all GEMs tools will be important to be sure this understanding is gained.
Additionally, since there are few 1:1 matches, and entirely new classifications included in ICD-10 that didn’t exist in ICD-9, the output or ICD-10 code offered by the GEMs tool will not always offer the best matches or choices. There are some ICD-9 codes are represented by several ICD-10 codes, and vice versa. Due to all this variation, a GEMs tool can give approximate matches, rather than exact matches. Sometimes the GEMs tools will not even offer all choices available. All of these situations can result in incorrect coding.
In summary, it is important for all GEMs users to understand that this tool is a simple mapping tool. It cannot take into account all of the patient encounter information that a coder or physician uses to choose the best and most applicable diagnosis. Therefore, while GEMs may be a good starting point, in the end an ICD-10 code book or encoder tool should always be used to insure clinical and coding accuracy.
To ensure accurate coding, and staying up to date on ICD-10 in general, be sure to regularly check in with your physician’s associations and software vendors for ICD-10 offerings. ADP AdvancedMD has provided an excellent ICD-10 website full of links, webinar information, etc for their client’s use. The website can be accessed via: myicd10.advancedmd.com
Additionally, ADP AdvancedMD is hosting a webinar, presented by the AAPC on the Impact of ICD-10. Follow the provided link to register for this webinar scheduled for June 26th 11am MDT. Impact of ICD-10 – AAPC Webinar