ICD-10-CM General Equivalence Mappings (GEMs) Coordination & Maintenance Committee Meeting September 28, 2007 CMS Headquarters—Baltimore.

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Presentation transcript:

ICD-10-CM General Equivalence Mappings (GEMs) Coordination & Maintenance Committee Meeting September 28, 2007 CMS Headquarters—Baltimore

2 Codes are... the currency of data transactions monitor health status of a defined population track trends in disease and treatment optimize delivery of healthcare govern reimbursement

3 Code Mapping & I-10 Implementation Mappings will be used to convert and test systems link data in long-term clinical studies develop application-specific mappings analyze data collected during transition period and beyond

4 Code Mapping is... an attempt to translate equivalent meaning from source to target one source system code linked to one or more target system codes

5 “ equivalent meaning” meaning... “an attempt to translate equivalent meaning from source to target” heavily dependent on the purpose of the map clinical mapping focuses on all possible meanings contained in source system code reimbursement mapping focuses on equivalent payment

6 Different is Good if the differences were not significant, no incentive to change clinical equivalent not possible in many cases

7 ICD-10-CM General Equivalence Mappings Presents all reasonable correspondences between the two code sets Consists of two general equivalence mappings (GEMs) ICD-9-CM to ICD-10-CM ICD-10-CM to ICD-9-CM Each file contains code pairs—one code from each set Source or target system code may be used more than once Additional information specified using flags

8 Presents All Reasonable Correspondences: All-inclusive

9 Presents All Reasonable Correspondences: Rule-based

10 Consists of Two GEM Files: I-9 to I-10 and I-10 to I-9 I-9  I-10 + flags 6822 L L L L L L L L L I-10  I-9 + flags O O O O O O O

11 Additional Information Specified in Flags Read as 1=On, 0=Off Three different flags Approximate No Map Combination

12 Approximate Flag 1 “On” = Approximate

13 No Map Flag 1 “On” = No Map

14 Combination Flag 1 “On” = Combination

15 Diagnosis GEMs User’s Guide

16 GEMs User’s Guide: Intro to Mappings

17 GEMs User’s Guide: How to Use GEM Files

18 GEMs User’s Guide: Glossary

19 GEMs User’s Guide: File and Format Info

20 Documentation and User’s Guide Posted on NCHS website with GEM files Revised as needed based on industry response