Tag Archives: GEMs

DIY ICD-10 conversion – Part 11

At the end of Part 9, we were translating a list of ICD-9 codes – a policy – into ICD-10. We used the 10-to-9 single GEMs with reverse lookup to find ICD-10 codes that should be in your ICD-10 version of the policy. We had some ICD-9 codes left over that no ICD-10 code translated to. You tried to look them up in the 9-to-10 single GEMs. You found some translated to ICD-10 codes already in your ICD-10 policy list, so you could feel assured that their meaning was taken care of. A few may have translated to single ICD-10 codes not already on your list. Those ICD-10 codes (“pink” in CTT) might be appropriate for your policy, but a clinical review of them was recommended.

Finding all the ICD-10 codes that might be on a patient’s record, and that might imply the patient satisfies the policy, is the objective of our process. Have we now found them all? Consider this case from Part 10: Continue reading

DIY ICD-10 conversion – Part 10

The time has come to talk about clusters. Back in Part 3 we defined them and in Part 7 we separated the GEMs into single-code and cluster tables. But we haven’t yet looked at them closely. We can’t put it off any longer.

Clusters come into play when something that you can say with one code in one system requires more than one code to say the same thing in the other system. A couple of examples will get us started.

Example 1: One ICD-9 diagnosis

073.0, Ornithosis with pneumonia Continue reading

DIY ICD-10 conversion – Part 6

Having defined a list of ICD-9 codes with a collective meaning as a “policy,” we are now embarking on using the GEMs (downloaded from CMS.gov in part 5) to help build a policy translation system. The GEMs, by the way, can be used to underpin types of code translations other than policy translations, so be warned that we are not talking about any sort of GEM-based code translation now – only policy translation. We will get to other types later.

Continue reading

Getting to the Good Stuff: An Active User’s Opinion of ICD-10

Like everyone, I’ve watched the back-and-forth comments on ICD -10. I know the AMA is still in opposition, but I really was quite amazed when I read the Medical Group Management (MGMA) study that tries to help explain one of the AMA’s reasons for opposition. MGMA did a study of ICD-10 preparedness among medical practices. Apparently the survey found a surprisingly high number of medical practices that rely on “unspecified” ICD-9 codes. In my opinion, that is unfortunate—no one should be using or paying for unspecified codes unless it is a new procedure or treatment that does not have a code to represent it yet. The pundit writing about the survey opined that “unspecified” will not work well in ICD-10, and this is one of the reasons why physicians are struggling. I beg to differ. Regardless of how specific the language is, there are still 22,728 ICD-10-CM diagnosis codes that contain “unspecified” in the code descriptor. So for those not clear on what they’re doing in ICD 9, fear not: there will still be plenty of unspecified codes in ICD-10!

Honestly, I am getting a bit frustrated with the talk and excuses of why the language is too expensive/won’t/can’t possibly/isn’t working. There must be some entities focused on moving forward other than the American Hospital Association (AHA) and the Blue Cross and Blue Shield Association. Is anyone out there working in ICD 10? Perhaps they are too busy using the language to write about it. Perhaps the professional organizations should focus on helping physician practices code accurately (even in ICD-9) rather than criticizing a language that will actually assist their members in the future. Using specific ICD-9 codes will help them choose even more specific ICD-10 codes. Continue reading

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 1

When our esteemed Medical Director is about to make a pronouncement about something outside his vast area of expertise, he usually starts by saying, “I’m just a country doctor, but …”

Well, I’m just a country computer programmer, but I think we should discuss the difference between a nomenclature and a classification. “Nomenclature” is the “N” in SNOMED. “Classification” is the “C” in ICD-9 or -10.

Why am I wandering into such dangerous waters, swarming with medical informaticists and other academic denizens capable of biting my head off, or at least splitting all my hairs? Because many people, in their desire to have an easy ICD-9 to ICD-10 transition, are setting their expectations of the GEMs too high. This manifests itself as requests for otherworldly extensions to software that I helped write. And though I’d do almost anything to keep my customers satisfied, I’m not a magician. Continue reading

Misusing the Reimbursement Map

The so-called Reimbursement Mapping is an ICD-10-code-to-ICD-9-code/cluster crosswalk available on the CMS website. It was created by taking each ICD-10-CM/PCS code and looking it up in the ICD-10–to–ICD-9 GEM. When only one ICD-9 translation was found there, it was left just as it is in the GEM entry, paired with the source ICD-10 code in the Reimbursement Map. When multiple alternatives were found, the ICD-9 alternative most frequently coded was used (based on ICD-9 Medicare data for everything but obstetrics and newborns and several years of commercial data for obstetrics and newborns).

The Reimbursement Mapping was developed by 3M under contract to CMS, in response to industry requests for a 10-to-9 crosswalk that could be used for payment. CMS did not create it for itself and has announced at every opportunity that CMS will not be using the mapping for any purpose whatsoever.

I can think of only two legitimate uses for the so-called Reimbursement Mapping: Continue reading

ICD-10 Translation Breadcrumbs

Some of our CTT (Code Translation Tool) users are especially fond of the way it creates audit trails. Every move they make—removing codes from lists, adding codes to lists, making notes about codes that need further research—is time-stamped and supplied, if they wish, with a comment giving the reason for the action. It makes sense—whenever I venture into territory I’m uncertain about, I like to leave a trail of breadcrumbs so I can get back if I get into trouble. Furthermore, some CTT users are consultants doing ICD-10 conversions for others, so they need to be able to show their clients how the codes on a client’s ICD-10 list got there.

CTT also has a feature that automates the update of a code list from one Fiscal Year to the next. If you have a list of ICD-10 codes that was created using the codes current in FY2011, you can have CTT automatically convert it to a list consistent with FY2013 codes, telling you about new codes, deleted codes, and GEMs changes when it does so. Continue reading