7 How are the General Equivalence Mappings Files Formatted? Below is an example from the ICD-10-CM diagnosis mapping: ➤ ICD-10-CM Source system code is on the left side; ➤ ICD-9-CM Target system code is in the middle; and ➤ Flags are on the right. ICD-10-CM ICD-9-CM Flags Source Code Target Code T1500xA 9300 10111 T1500xA E914 10112 T1500xD 9300 10111 T1500xD E914 10112 T1500xS 9085 10000 ➤ T1500xA Foreign body in cornea, unspecified eye, initial encounter n To ICD-9 cluster: — 9300 Corneal foreign body — E914 Foreign body accidentally entering eye and adnexa ➤ T1500xD Foreign body in cornea, unspecified eye, subsequent encounter n To ICD-9 cluster: — 9300 Corneal foreign body — E914 Foreign body accidentally entering eye and adnexa ➤ T1500xS Foreign body in cornea, unspecified eye, sequela n To 9085 Late effect of foreign body in orifice 4 The flags are read as: ➤ 1 = On ➤ 0 = Off There are three different flags: ➤ “Approximate” is Flag 1, which is in column 1 of the flags: n 1 means the translation is an Approximate match — The majority of alternatives are considered an Approximate match n 0 means the translation is an Identical match General equivalence MappinGS — Rare in the Procedure GEMs — More common in the Diagnosis GEMs n Example of Diagnosis Approximate match (1), not Identical match — T1500xA 9300 10111 — T1500xA E914 10112 — Each of these codes is an Approximate match n Example of diagnosis Identical match (0) — 41411 12542 00000 — ICD-9-CM code 414.11 is an Identical match to ICD-10-CM code 12542 Second in SerieS ➤ “No Map” is Flag 2, which is in column 2 of the flags: n 1 means there is no plausible translation for the source system code n 0 means there is at least one plausible translation for the source system code n Notice the NODX “No Description Found” entry instead of a code number in middle column T500x6A NODX 11000 T500x6D NODX 11000 T500x6S NODX 11000 — T500x6A Underdosing of mineralocorticoids and their antagonists, initial encounter — To NODX No description found — T500x6D Underdosing of mineralocorticoids and their antagonists, subsequent encounter — To NODX No description found — T500x6S Underdosing of mineralocorticoids and their antagonists, sequela — To NODX No description found ➤ “Combination” is Flag 3, the scenario and choice list flags: n 1 means code maps to more than one code n 0 means the code maps to a single code n Flags 4 and 5 further clarify combination entries (See the User’s Guides for complete information on these flags) ICD-10-CM ICD-9-CM Flags Source Code Target Code T1500xA 9300 10111 T1500xA E914 10112 T1500xD 9300 10111 T1500xD E914 10112 5 T1500xS 9085 10000 — T1500xA Foreign body in cornea, unspecified eye, initial encounter — To ICD-9 cluster (Flag 3 is 1) — 9300 Corneal foreign body — E914 Foreign body accidentally entering eye and adnexa — T1500xD Foreign body in cornea, unspecified eye, subsequent encounter — To ICD-9 cluster (Flag 3 is 1) — 9300 Corneal foreign body — E914 Foreign body accidentally entering eye and adnexa — T1500xS Foreign body in cornea, unspecified eye, sequela (Flag 3 is 0) — To 9085 Late effect of foreign body in orifice 8 Is There a One-to-One Match Between ICD-9-CM and ICD-10? No, there is not a one-to-one match between ICD-9-CM and ICD-10, for which there are a variety of reasons including: ➤ There are new concepts in ICD-10 that are not present in ICD-9-CM; ➤ For a small number of codes, there is no matching code in the GEMs; ➤ There may be multiple ICD-9-CM codes for a single ICD-10 code; and ➤ There may be multiple ICD-10 codes for a single ICD-9-CM code. 9 Are There Instances When it is Not Necessary to Use the General Equivalence Mappings? In the following instances, it may not be necessary to use the GEMs: ➤ When a small number of ICD-9-CM codes are being converted to ICD-10-CM and PCS codes, it may be quicker, easier, and more accurate to simply look up the codes in an ICD-10-CM or PCS book; and ➤ When ICD-10 is implemented on October 1, 2013, coders will use coding books or encoder systems to code rather than using the GEMs. HELPFUL WEB SITES General ICD-10 Information Official CMS Industry Resources for the ICD-10 Transition http://www.cms.gov/ICD10 www.cms.gov/ICD10 General Equivalence Mappings and User’s Guides ICD-9-CM Notice http://www.cms.gov/ICD10/13 The International Classification of Diseases, 9th Revision, Clinical Modification _2010_ICD10PCS.asp (ICD-9-CM) is published by the United States Government. A CD-ROM, which may be purchased through the Government Printing Office, is the only official Federal government version of the ICD-9-CM. ICD-9-CM is an official Health Insurance http://www.cms.gov/ Portability and Accountability Act standard. ICD10/12_2010_ICD_10_CM.asp 6 April 2010