Official CMS Industry Resources for the ICD-10 Transition www.cms.gov/ICD10 The General Compliance Timeline Equivalence Mappings Use the GEMs When… JANUARY 1, 2010 • ayers and providers should begin internal P • You are translating lists of codes, code tables, or other coded testing of Version 5010 standards for electronic claims data DECEMBER 31, 2010 • You are converting a system or application containing ICD-9-CM • nternal testing of Version 5010 must be I codes complete to achieve Level I Version 5010 compliance • You are creating a “one-to-one” applied mapping (aka crosswalk) JANUARY 1, 2011 between code sets that will be used in an ongoing way to translate records or other coded data • ayers and providers should begin external P testing of Version 5010 for electronic claims • You want to study the differences in meaning between the • MS begins accepting Version 5010 claims C ICD-9-CM classification systems and the ICD-10-CM/PCS • ersion 4010 claims continue to be accepted V classification systems by looking at the GEMs entries for a given code or area of classification DECEMBER 31, 2011 • xternal testing of Version 5010 for electronic E claims must be complete to achieve Level II Use the ICD-10-CM/PCS and ICD-9-CM Version 5010 compliance Code Books When… JANUARY 1, 2012 • ll electronic claims must use Version 5010 A • You have a short list of ICD-9-CM codes with their code descriptions • ersion 4010 claims are no longer accepted V OCTOBER 1, 2013 • You have access to the medical record • laims for services provided on or after this C • You have access to other forms of clinical information, such as date must use ICD-10 codes for medical diagnosis and inpatient procedures text descriptions or clinical terms from surveys, research, or clinical software applications • PT codes will continue to be used for C outpatient services Note: A medical record that will be processed and stored as ICD-10 data should always be coded directly in ICD-10-CM/PCS, using the code books or an encoder. Visit www.cms.gov/ICD10 for ICD-10 and Version 5010 resources from CMS. MAY 2010 Official CMS Industry Resources for the ICD-10 Transition www.cms.gov/ICD10 GEMs Files at a Glance ICD-10-CM (diagnosis) ICD-9-CM Diagnosis ICD-10-PCS (procedure) ICD-9-CM Procedure GEM GEM GEM GEM [year]_I10gem.txt [year]_I9gem.txt gem_pcsi9.txt gem_i9pcs.txt ICD-10-CM is the code to be ICD-9-CM is the code to be ICD-10-PCS is the code to be ICD-9-CM is the code to be translated (source system) translated (source system) translated (source system) translated (source system) Contains all ICD-10-CM codes Contains all ICD-9-CM Contains all ICD-10-PCS Contains all ICD-9-CM diagnosis codes codes procedure codes Note: Each GEM file contains all of the source system codes Note: Each GEM file contains Note: Each GEM file contains Note: Each GEM file contains for that GEM, but not all of the all of the source system codes all of the source system codes all of the source system codes target system codes for that GEM, but not all of the for that GEM, but not all of the for that GEM, but not all of the target system codes target system codes target system codes Translation determined by Translation determined by Translation determined by Translation determined by ICD-10-CM meaning and ICD-9-CM meaning and ICD-10-PCS meaning and ICD-9-CM meaning and specificity specificity specificity specificity Note: The GEM translation is Note: The GEM translation is Note: The GEM translation is Note: The GEM translation is determined by the meaning determined by the meaning determined by the meaning determined by the meaning and specificity of the source and specificity of the source and specificity of the source and specificity of the source system code system code system code system code Contains ICD-9-CM clusters Contains ICD-10-CM clusters Contains ICD-9-CM clusters Contains ICD-10-PCS clusters Contains entries with no target Contains entries with no target All source system entries have Contains entries with no target system translation system translation a target system translation system translation (No Map Flag is 1) (No Map Flag is 1) (No Map Flag is 0) (No Map Flag is 1) Recommended use Recommended use Recommended use Recommended use – Convert an existing – Convert stored data – Convert an existing – Convert stored data application that uses ICD- containing ICD-9-CM application that uses ICD- containing ICD-9-CM 9-CM codes to ICD-10- codes to ICD-10-CM 9-CM codes to ICD-10- codes to ICD-10-PCS CM PCS – Research the translation – Research the translation – Create a backward differences between the – Create a backward discontinuities between mapping from ICD-10-CM two diagnosis code sets mapping from ICD-10- the two procedure code to ICD-9-CM PCS to ICD-9-CM sets – Research the translation – Research the translation differences between the discontinuities between two diagnosis code sets the two procedure code sets MAY 2010 Official CMS Industry Resources for the ICD-10 Transition www.cms.gov/ICD10 Using GEMs File(s) for Specific Projects Mapping Project GEMs File to Use How to Use the GEMs File Convert an existing system or application ICD-10-CM (diagnosis) GEM – Re-sort the file so that you can look up the that uses ICD-9-CM codes to an ICD-10- [year]_I10gem.txt relevant GEMs entry based on the ICD-9- CM/PCS based system CM code (aka reverse lookup) ICD-10-PCS (procedure) GEM gem_pcsi9.txt – Find all translation alternatives for the ICD- 9-CM code(s) in your applications list or table – Replace the ICD-9-CM code(s) with the ICD-10-CM/PCS translation alternatives – Review the translated ICD-10-CM/PCS list for relevance of the code detail to the specific use for the list and application Convert an existing data warehouse or ICD-9-CM diagnosis GEM – Find all GEMs entries for every ICD-9-CM other stored data containing ICD-9-CM [year]_I9gem.txt code that contains multiple ICD-10-CM/ codes to ICD-10-CM/PCS (create a PCS translation alternatives forward mapping) ICD-9-CM procedure GEM gem_i9pcs.txt – Based on a consistent set of rules or reference data, choose one ICD-10-CM/ PCS mapping for each ICD-9-CM code that translates to multiple ICD-10-CM/PCS alternatives Note: Because of translation differences between the two systems, “one” ICD-9-CM code may map to “one” ICD-10-CM/PCS cluster Create a “one to one” backward mapping ICD-10-CM (diagnosis) GEM – Find all GEMs entries for every ICD-10-CM/ from ICD-10-CM/PCS to ICD-9-CM for a [year]_I10gem.txt PCS code that contains multiple ICD-9-CM specific purpose translation alternatives ICD-10-PCS (procedure) GEM gem_pcsi9.txt – Based on a consistent set of rules or reference data (rules that pick the correct code for a service area or the most frequently recorded ICD-9-CM code), choose one ICD-9-CM mapping for each ICD-10-CM/PCS code that translates to multiple ICD-9-CM alternatives Note: Because of translation differences between the two systems, “one” ICD-10-CM/ PCS code may map to “one” ICD-9-CM cluster MAY 2010 Official CMS Industry Resources for the ICD-10 Transition www.cms.gov/ICD10 Mapping Project GEMs File to Use How to Use the GEMs File Research the translation differences ICD-10-CM (diagnosis) GEM – Find the code of interest in both GEM files between the two diagnosis code sets, for [year]_I10gem.txt your own understanding or for planning – Compare the translation alternatives for future changes to a system or application ICD-9-CM diagnosis GEM the code of interest, when it is the source [year]_I9gem.txt system code (the code being translated) and when it is the target system code (a translation alternative of a code in the other code set) Note: The code of interest may not be listed as a target system alternative; this in itself is useful information, to learn that the code is not considered a plausible translation based on the meaning and specificity of the source system code Research the translation discontinuities ICD-10-PCS (procedure) GEM – Find the code of interest in both GEM files between the two procedure code sets, for gem_pcsi9.txt your own understanding or for planning – Compare the translation alternatives for future changes to a system or application ICD-9-CM procedure GEM the code of interest, when it is the source gem_i9pcs.txt system code (the code being translated) and when it is the target system code (a translation alternative of a code in the other code set) Note: The code of interest may not be listed as a target system alternative; this in itself is useful information, to learn that the code is not considered a plausible translation based on the meaning and specificity of the source system code Glossary Applied mapping: distillation of a reference mapping to conform to the needs of a particular application (e.g., data quality, research) Backward mapping: mapping that proceeds from a newer code set to an older code set Cluster: in a combination entry, one instance where a code is chosen from each of the choice lists in the target system entry, that when combined satisfies the equivalent meaning of the corresponding code in the source system Forward mapping: mapping that proceeds from an older code set to a newer code set General Equivalence Map (GEM): reference mapping that attempts to include all valid relationships between the codes in the ICD-9- CM diagnosis classification and the ICD-10-CM diagnosis classification ICD-9-CM: International Classification of Diseases 9th Revision Clinical Modification ICD-10-CM: International Classification of Diseases 10th Revision Clinical Modification No map flag: attribute in a GEM that when turned on indicates that a code in the source system is not linked to any code in the target system Reverse lookup: using a GEM by looking up a target system code to see all the codes in the source system that translate to it Source system: code set of origin in the mapping; the set being mapped ‘from’ Target system: destination code set in the mapping; the set being mapped ‘to’ MAY 2010 Official CMS Industry Resources for the ICD-10 Transition www.cms.gov/ICD10