Category Archives: GEMs

General Equivalence Mappings; ICD-9-CM; ICD-10-CM; ICD-10-PCS; data translation; medical codes; medical coding tables; classification systems; applied mapping; system conversion; converting applications; backwards mapping; health information; electronic health record; EHRs; Center for Medicaid & Medicare Services; CMS; healthcare federal mandates

Nomenclature vs. Classification – Part 3

Previously on Imelda’s World: You invented SNOFOO to standardize the nomenclature of footwear, so your servants can talk about your (by now 15,000) pairs of shoes unambiguously via their EFRs. You invented the ICF-9 classification to assign each pair to one of 256 mutually exclusive and exhaustive cubbyholes. When that became too restrictive for your growing collection, you got 2048 new cubbyholes and invented a new and better classification, ICF-10. Because people were using the cubbyhole number as a shorthand for a partial description of the types of shoes found in a cubbyhole, you invented the CHEMs to help them go back and forth between the two classifications.

Now you are wondering whether the CHEMs were such a good idea. People (other than cubbyholers) seem to think that ICF-10 is just a simple expansion of ICF-9. Now that you have eight times as many cubbyholes, they think you just took each of the original 256 and neatly subdivided the shoes in each cubbyhole, distributing them in the new, roomier structure. How many times, you wonder, do you have to explain to them that, while this is very often true, you also took into account changes in shoe fashion, not to mention changes in your own opinions about the best way to organize? Some categories disappear, some are severely reduced, new categories are introduced, and some whole chapters in the ICF-9 book are completely reorganized (for example, maternity shoes). Continue reading

Nomenclature vs. Classification – Part 2

You did such a good job playing the role of Imelda in Part 1 (nomenclature), are you ready to resume for Part 2 (classification)?

Good. Let’s get started. You’ve more or less solved the problem of talking about your 10,000 pairs of shoes (admirers send new ones every day), but the big headache now is how to find them when you want them.

Then, for your birthday, your husband, Ferdie, adds a new room to the palace with 256 big bins, or “cubbyholes,” as your servants prefer to call them. So you and they get right to work. You soon realize that no single attribute sorts the shoes into 256 neat categories. Color, for example: the “black” cubbyhole would be overflowing onto the floor while the “puce with lime heels” would have only one pair in it. After nine tries, you finally get a scheme that works well enough, so you have it written down as Imelda’s Classification of Footwear (ICF-9). Copies are distributed to the full-time shoe servants—“cubbyholers” they call themselves—and pretty soon they are forming groups like the Cubbyholers of Imelda Meeting Annually (CHIMA) to promote “correct cubbyholing.” Continue reading

What No Map Can Tell You about ICD-10: Coronary Angioplasty and MS-DRGs, Part 2

Last time I exhausted my blog space and myself and probably a few readers describing in principle how the differences in the language of ICD-9 and ICD-10 impact the MS-DRG assignment of angioplasty procedures. In this blog, it’s time to get off the soapbox and play in the sandbox. Here is a sample set of procedure scenarios we can mess around with to show how they will be coded and reimbursed in the past, the future, and in the fun house mirror view you sometimes get from mapping.

First, a quick review of the differences in angioplasty coding between ICD-9 and ICD-10, and the MS-DRGs assigned for coronary artery procedures. Continue reading

What No Map Can Tell You about ICD-10: Coronary Angioplasty and MS-DRGs, Part 1

Everyone on the planet knows what a coronary angioplasty is, since it makes the news every time someone in public office gets their coronaries reamed out.  Angioplasties happen—a lot—and when they do happen, because of significant differences in the language of procedure coding between ICD-9 and ICD-10, even the best map cannot predict actual financial impact. You may have heard me once or twice say, “of course the differences between ICD-9 and ICD-10 are significant, otherwise there would be no point in switching.”* Here is a classic case of that sentence at work in the real world.

The crux of the difference is in how the coronary arteries themselves are classified. In ICD-9, the axis of classification is the number of distinct coronary vessels treated—the left anterior descending, the right main, the obtuse marginal, and so forth. In ICD-10, the axis of classification for coronary artery procedures is the total number of sites treated, regardless which coronary artery it is. Continue reading

ICD-10 Basics: Advancing Healthcare IT

By: Ann Frischkorn Chenoweth

Upgrading to ICD-10 is a necessary step in realizing health IT potential. ICD-10 data are more easily retrieved in electronic format than ICD-9 data.   Because the code set is more robust and up-to-date, it offers better mapping from SNOMED CT.   The full benefits of a reference terminology such as SNOMED CT will not be realized if that system is mapped to an obsolete classification system such as ICD-9-CM.

Computer Assisted Coding (CAC) offers improved coding consistency, efficiency, and accuracy.   The detailed and logical structure of ICD-10 simplifies the development of map rules and algorithms used in CAC applications. As a result, ICD-10 more easily enables CAC.

ICD-10 is a good opportunity to phase out aging and inflexible systems or to modernize legacy systems.  Many CIOs I’ve met with state they are leveraging their ICD-10 readiness/system inventory work to consolidate redundant applications.  Moreover it is giving them an opportunity to look for new platforms and vendor solutions which can be used across the enterprise.

New Year’s Resolution: No More Harping

By: Ron Mills

A well-understood maxim among software developers states that there is generally a difference between:

  • what users say they want
  • what users want
  • what users need

The difference between the first two is one of communication and is easily solved by quickly prototyping what they say they want, so they can say “that isn’t what I want” and start pointing.

The chasm between want and need is much harder to bridge. In the short term, you can make plenty of money giving people what they want, but if you are in the game for the long haul, you ignore the difference at some peril to your reputation. When the system you build fails to solve their problem, are they more likely to come back and say “let’s try again” or will they go somewhere else?

Knowing what the user needs isn’t so easy, of course.

Continue reading

ICD-10-CM/PCS MS-DRG Grouper Q&A Part 2

By: Ron Mills

“Mike” wrote Rhonda:

I saw a good article you wrote in The Journal of AHIMA … been very helpful … but the bigger question we are encountering is the continuity of reporting from ICD9 to ICD10. I am hoping you may be able to point me in the direction of any work that has been done on supporting data warehousing, reporting and information challenges when the data spans 2013 and the ICD-9 and ICD-10 code sets.

Rhonda passed it on to me and I responded:

Mike, you’ve got a good* problem on your hands. Here’s what I’ve been doing with the mixed ICD-9/ICD-10 databases I’ve been dealing with, those behind the extension of our products to handle ICD-10. I keep the database structure the same, but recode the ICD-9 codes so they don’t overlap with ICD-10. (See my “False Friends” blog for details.) I put “9$” in front of ICD-9 diagnoses and “I$” in front of ICD-9 procedures, so they can live in the same places as ICD-10 — the ICD-9 becomes an extension of ICD-10 in this system. Since there are roughly 140,000 ICD-10 codes and only about 17,000 ICD-9 codes, that is only a 12% increase in the number of codes being considered. Since code types are not ever mixed at the record level, a code type indicator in the record serves as well, but may require more complicated selection logic.

Continue reading

ICD-10-CM/PCS MS-DRG Grouper Q&A Part 1

By: Ron Mills

Since the series on the ICD-10 MS-DRG grouper, I’ve been getting some good questions about it in email, so I propose to share some of the answers in this space. So here we go with caller number one:

I wish to test the ICD-10 MS-DRG grouper from NTIS on patient records from my facility. Must I choose among all the ICD-10 alternatives for each ICD-9 code or should I take all possible combinations suggested by the GEMs? If I have to choose, can I just run the Reimbursement Map backwards on the ICD-9 data?

Continue reading

GEMs Use Ground Rules

By: Rhonda Butler

This blog is a summary of many of the points I have been trying to make about the GEMs over the last several months. After this blog I will lay off the subject of the GEMs for awhile, and concentrate on other aspects of ICD-10.

There are three basic ground rules every user of the GEMs should be aware of. The GEMs

  1. Are a code translation referencenot a medical record converter and not a crosswalk
  2. Assume the user has no access to the original medical record
  3. Are not “plug and play”—cannot be used as is to create fully automated translation

These three constraints need to be taken into account for correct, efficient use of the GEMs.

Continue reading

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?

Continue reading