CMS explains General Equivalency Mappings (GEMs)

CMS has created a tool that can help ease the process for mapping out equivalent codes between ICD-9 and ICD-10.

On May 19, CMS hosted an ICD-10-CM/PCS implementation and General Equivalence Mappings (GEM) national provider conference call to further explain the GEMs and how to use them.  JustCoding.com recently posted a story, “CMS explains general equivalency maps to help the industry transition from ICD-9 to ICD-10,” which highlights information a CMS representative presented to explain how the agency used the GEMs to convert one major diagnostic category (MDC) in the MS-DRG system from ICD-9 to ICD-10. Click on the link above to read this story in its entirety. (You must be a JustCoding.com member to access this article)

CMS used the GEMs to convert three MS-DRGs related to inflammatory bowel disease in MDC 6 (digestive system). Using the GEMs, it found that although there are four principal diagnosis codes for enteritis in ICD-9-CM (i.e., 555.0, 555.1, 555.2, and 555.9), there were 28 equivalent codes in ICD-10-CM. From this experience, CMS determined that the GEMs were indeed effective in facilitating this conversion, said Pat Brooks, RHIA, the senior technical advisor for CMS’ Hospital and Ambulatory Policy Group.

In its General Equivalence Mapping: Top 10 Question and Answer Fact Sheet, CMS says the intended audiences for the GEMs are coding professionals, payers, providers, medical researchers, informatics professionals, and any other individuals who use coded data. These individuals can use the GEMs to convert payment systems, payment and coverage edits, risk adjustment logic, quality measures, and a variety of research applications that involve trend data.

Have you taken a closer look at the GEMs? You can access the presentation that was covered in this CMS call, the GEMs Fact Sheet, and a transcript of the call on the CMS Web site.

Let us know what you think of the GEMs and how you plan to use these tools.