Most top tier EMR/EHR software systems will include an ICD-10 General Equivalency Mapping (GEM) tool to assist you and your administrative personnel with side-by-side medical coding. The software’s GEM functionality translates diagnostic and procedural codes from ICD-9 to ICD-10 and offers other critical information that connects codes in ICD-9 to codes in ICD-10, such as:
- Calculation of payment for medical services rendered
- Documentation of patient diagnosis, health state, or mortality
- Conversion of ICD-9-based software to ICD-10-CM/PCS (i.e. different research apps that Incorporate trends, quality measures, remittance systems, insurance benefits and coverage records, etc.)
GEMs enable you to map from ICD-9-CM codes to ICD-10-CM and PCS codes bi-directionally, so if you are currently coding in ICD-9-CM, you may look up the comparable ICD-10-CM code(s) as you train for ICD-10. Ensure that your ICD-10 side-by-side coding capability contains all ICD-9-CM codes and ICD-10-CM and PCS codes in order to eliminate the risk of inaccuracies due to omitted coding information. Further, GEMs normally contain every possible mapping combination between ICD-9 and ICD-10, as well as many ICD-10-specific codes and information not found in ICD-9.
However, cases exist where no feasible translation can be made between an ICD-9-CM code and an ICD-10 code. For instance, ICD-9-CM doesn’t have a corresponding code for ICD-10-CM code Y71.3 – Surgical instruments, materials, and cardiovascular devices (including sutures) associated with adverse incidents. On the flip side, ICD-10-PCS doesn’t have a matching code for ICD-9-CM procedure code 89.8 – Autopsy.
Keep in mind that ICD-10 is a far more specific, detailed, and expansive medical coding system than ICD-9. The diagnosis codes in ICD-9-CM expanded from 14,567 to 69,832 ICD-10-CM codes and the procedural codes increased from 3,882 ICD-9 to 71,924 ICD-10-PCS codes. (As a side note, physicians in specialty-specific practices may continue to utilize Current Procedural Terminology (CPT) coding for out-patient procedures.)
While one-to-one translations between ICD-9 and ICD-10 codes do occur (which doesn’t necessarily mean that they are exactly the same), physicians and practice staff will often find that an ICD-9 code will have several possible ICD-10 translations because of ICD-9’s more general nature. GEMs are programed to bring up all ICD-10 translation alternatives for an ICD-9 code based on relevant Coding Clinic advice, index entries, and other regulations.
ICD-10 side-by-side coding is a useful guide, but it doesn’t replace the ICD-10 training physicians and medical staffs need to go through. That is, a physician can’t put in an ICD-9 code for clinical treatment and solely rely on a GEM to bring up the correct ICD-10 code every time. Why? ICD-10 has updated and new medical concepts that don’t exist in the previous edition, and a physician will not always get a code match between the two ICD editions. Additionally, ICD-9 may have multiple codes for one ICD-10 code, and ICD-10 may have several codes for one ICD-9 code.
Training on ICD-10-CM as it pertains to a physician’s specialty will make ICD-10 coding significantly easier, more efficient, and accurate. Use an ICD-10-CM or PCS code book or electronic dictionary to look up the specific codes applicable to your medical services. ICD-10 mapping tools, however, should also be used to gain familiarity with ICD-10 as your prepare insurance claims for filing. As a suggestion: try double-coding in ICD-9 and ICD-10 for your most common types of clinical treatments so you get some idea of what it takes to successfully code in ICD-10 and file a claim. This practice will also assist you in spotting any problematic areas that need to be resolved before the ICD-10 implementation deadline on October 1, 2015.
Take advantage of ICD-10 GEMs and training to make your ICD-10 preparations smoother and minimize the risk of insurance denials and lack of reimbursement after the ICD-10 deadline.
The Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) led the development of GEMs, with additional involvement from the American Hospital Association (AHA) and the American Health Information Management Association (AHIMA), over a span of three years. CMS and CDC update GEMs in accordance with ICD-10 updates on an annual basis before the implementation deadline. These organizations will continue to monitor and update these GEMs for a minimum of three years after October 1, 2015.