All Entries Tagged With: "GEMs"
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.
CMS seeks feedback from the industry on a potential code freeze
On May 19, CMS hosted a conference call during which it addressed the use of General Equivalence Mappings (GEMs). A transcript of the call is now available on the CMS Web site.
CMS representative Pat Brooks, RHIA, senior technical advisor for the hospital and ambulatory policy group highlighted an important agenda item that will be discussed at the September 16-17 ICD-9-CM Coordination and Maintenance meeting.
Many in the industry have expressed to CMS that they feel it is important for CMS and Centers for Disease Control and Prevention to consider freezing updates to the ICD-9-CM and ICD-10 coding systems prior to the October 1, 2013 implementation. Many have said that freezing the codes would make it easier to develop educational materials for the implementation without worrying about updating them each year. Many people also said that they felt this kind of freeze would help vendors develop products.
In the ICD-10 final rule, CMS said that it would take this issue to the ICD-9 Coordination and Maintenance Committee and seek input from various providers and vendors and others on what they thought about this suggestion. CMS will pose the following questions at that September 16-17 meeting:
- Should there be a freeze?
- If so, should it be of both ICD-9 and ICD-10 or one or the other?
- When should the freeze begin? For example, should October 1, 2012 be the last time ICD-9-CM codes and ICD-10-CM and PCS codes are updated? Or should a freeze be established as early as 2011?
“These are the kinds of things we need to know from the industry,” Brooks said during the call. “We’ll be actively soliciting input from you to speak about whether there should be a freeze, and if so, when should the freeze be? Come to the meeting and discuss this.”
You can register for this meeting beginning August 14. Or write to CMS after the meeting, and provide your own input. Be sure to answer the following questions:
- How important would this freeze be to your organization?
- Should ICD-9-CM and/or ICD-10 be frozen prior to ICD-10 implementation?
- When should the freeze begin?
