So What is the 9 to 10 GEM Good For Anyway?

By: Rhonda Butler

In my last blog I talked about why you almost never want to use the 9 to 10 GEM, because in the vast majority of cases it answers a different question than the one you are asking, usually:

What are all the I-10 codes that will be used in 2013 to capture the information currently classified to this I-9 code?

The 9 to 10 GEM is also fondly called the “garbage in garbage out” translation, because in the typical case the I9 code is less specific than I-10, and the 9 to 10 GEM gives only the non-specific I-10 translation. But that is the typical case. What about the atypical case? Believe it or not, there are lots of I-9 codes that are actually more detailed than I-10. This comes as a surprise to most people. They say, with all those thousands of new codes, isn’t I-10 always more detailed than I-9? And if not, why not?

The first answer is yes, most of the time but not always. And the second answer has two parts. For diagnosis codes, the level of detail in some I-9 codes was either considered outmoded, problematic as data, or the classification got restructured. For procedure codes, I-9 and PCS are structured so differently that it is inevitable that some I-9 codes contain more detail along some dimensions.

The 9 to 10 GEM exposes these cases where I-9 is more detailed than I-10. Any decent GEMs lookup tool can show you this. If you look up an I-9 code and ask to see an integrated translation of all GEMs entries to or from that I-9 code (All GEM in the CTT Viewer) if the translations say “To” only and not “To/From” it means that the I-9 code is more detailed than the I-10 code it is translated to. In GEMs lingo, your I-9 code is used in the 9 to 10 GEM, but not use in the 10 to 9 GEM.

The bottom line first, and then an example for those who find it useful. The bottom line is, I-9 can sometimes contain more detail than its I-10 counterpart. But an important thing to remember is, you need to know which I-9 codes are more detailed than their I-10 counterparts only if your organization uses a specific code to find a specific group of patients. Otherwise the fact that there is less detail in a given I-10 code is not going to impact your organization. In the example below I discuss the I-9 codes for uncontrolled diabetes. If your organization does not track uncontrolled diabetes patients separately from other diabetes patient, then the fact that the word “uncontrolled” is not used in I-10 diabetes codes has no impact.

EXAMPLE

There are a bunch of codes that specify “uncontrolled diabetes” in I-9. They look like this:

250.02 Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled

In the GEMs, they translate one way only as shown in the CTT Viewer, like this:

250.02 Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled

To E11.65 Type 2 diabetes mellitus with hyperglycemia

This means in this case the I-9 code is more specific than the I-10 code—or if you prefer, it says something different. In GEMs lingo, it means that diabetes with hyperglycemia is the closest I-10 translation for uncontrolled diabetes, but the I-10 code doesn’t actually say uncontrolled diabetes. And to prove it, in the 10 to 9 GEM the I-10 code actually translates to a different I-9 code, like this:

E11.65 Type 2 diabetes mellitus with hyperglycemia

To 250.80 Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled

Rhonda Butler is a Senior Clinical Research Analyst with 3M Health Information Systems.

2 responses to “So What is the 9 to 10 GEM Good For Anyway?

  1. Hi Rhonda,
    In this blog, you mention a CTT viewer for looking at GEMs translations. Can you describe where that might be found?

  2. Thanks for your interest. The CTT viewer is part of a suite of products collectively called the 3M ICD-10 Code Translation Tool, or CTT for short. You can find more information at http://multimedia.3m.com/mws/mediawebserver?mwsId=SSSSSu7zK1fslxtUnY_UOxtZev7qe17zHvTSevTSeSSSSSS–&fn=icd10_code_trans_tool_fs.pdf.

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