All Entries Tagged With: "General Equivalency Mappings"
CMS posts slide presentation explaining MS-DRG conversion project
I was poking around the CMS Web site today, in the ICD-10 section of course, and I noticed a brand new page devoted to the ICD-10 MS-DRG Conversion Project. While I’ve heard different CMS representatives discuss this conversion the agency has been working on for many months now, this page provides a great deal of specifics, including a slide presentation dated September 16, which details the project and a number of what it refers to as “resolved issues.”
In this section, you’ll also find a document that describes how CMS got to this point in the MS-DRG Conversion Project. The document states:
The project was an exercise to evaluate the effectiveness of the General Equivalence Mappings (GEMs) and to learn how best to use them in converting data. The GEMs are a tool that assist in converting ICD-9-CM codes to the relevant ICD-10-CM/PCS codes (forward mapping) and ICD-10-CM/PCS codes back to the relevant ICD-9-CM codes (backward mapping). The GEMs were developed to assist CMS as well as all other data users who would need to convert ICD-9-CM data or payment systems to ICD-10-CM/PCS codes.
CMS also provides the draft ICD-10-CM/PCS MS-DRG V26 Definitions Manual in the downloads section in both text and HTML versions with condensed and full title formats.
Final ICD-10 MS-DRG logic will be subject to rulemaking.
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.
Monitor CMS’ ICD-10 Q&As
With all the complexities related to the implementation of ICD-10, it’s no wonder that so many in the healthcare industry have a number of questions related to the various aspects of this new coding system. While the list of questions and answers posted on this CMS Web page is not as extensive as you might hope, CMS has addressed a number of common queries and provided helpful links within the posts. Consider the following Q&A:
QUESTION: Are there any instances when there is no translation between an International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) code and an International Classification of Diseases, 10th Edition (ICD-10) code? How do the General Equivalency Mappings handle this situation?
ANSWER: Yes, there are instances where there is not a translation between an ICD-9-CM code and an ICD-10 code. When there is no plausible translation from a code in one system to any code in the other system, the “No Map” flag indicates this. 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
- ICD-9-CM procedure code 89.8 – Autopsy, which has no reasonable translation in ICD-10-Procedure Coding System.
For more information on this subject, see page 16 of the publication titled Procedure Code Set General Equivalence Mappings ICD-10-PCS to ICD-9-CM and ICD-9-CM to ICD-10-PCS 2009 Version Documentation and User’s Guide. The User’s Guide is posted in the Downloads Section within the file labeled “2009 Mapping – ICD-10-PCS to ICD-9-CM and ICD-9-CM to ICD-10-PCS; and User Guide, Reimbursement Guide, Diagnosis, and Procedures.”
On May 19, CMS hosted a conference call during which it addressed in further detail the use of General Equivalence Mappings (GEMs). The CMS representative said they had about 6,000 registrants for the call, so it looks like many of you are in planning mode, which is great news! A transcript of the call will be available on the CMS Web site soon.
