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GEMs | 3M HIS Blog
Posted on February 25, 2015 by Rhonda Butler | Leave a comment
Posted in ICD-10	Tagged CMS, GEMs, ICD-10	DIY ICD-10 conversion – Part 11
Posted on March 24, 2014 by Ron Mills | 1 comment
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 →
Posted in ICD-10	Tagged DIY ICD-10, GEMs, ICD-10, ICD-9, translating policies	DIY ICD-10 conversion – Part 10
Posted on March 17, 2014 by Ron Mills | 4 comments
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 →
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Posted in ICD-10	Tagged Clusters, coding, GEMs, handling clusters, ICD-10, ICD-9	DIY ICD-10 conversion – Part 6
Posted on January 15, 2014 by Ron Mills | 2 comments
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.
Posted in ICD-10	Tagged conversion, DIY ICD-10, GEMs, Policy	Getting to the Good Stuff: An Active User’s Opinion of ICD-10
Posted on July 31, 2013 by Barbara Aubry | 2 comments
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 →
Posted in ICD-10	Tagged GEMs, ICD-10, ICD-9, MGMA	Nomenclature vs. Classification – Part 3
Posted on May 13, 2013 by Ron Mills | 5 comments
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 →
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Posted in ICD-10	Tagged classification, GEMs, nomenclature, SNOMED, SNOMED v. classification	Nomenclature vs. Classification – Part 1
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 →
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Posted in ICD-10, Interoperability and Standards	Tagged classification, GEMs, nomenclature, SNOMED, SNOMED v. classification	Misusing the Reimbursement Map
Posted on April 10, 2013 by Ron Mills | 2 comments
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).
I can think of only two legitimate uses for the so-called Reimbursement Mapping: Continue reading →
Posted in ICD-10	Tagged 10-to-9 crosswalk, GEMs, ICD-9	ICD-10 Translation Breadcrumbs
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 →
Posted in ICD-10	Tagged GEMs	Email Subscription
Revolutionizing Coding ValueICD-10: After the Thaw Rhonda ButlerHIMagine That! Queries for ICD-10 Sue Belley and Donna SmithTaking a Closer Look at the June ICD-10 Coding Challenge Sue Belley	Accelerating the EHRHIMagine That! Queries for ICD-10 Sue Belley and Donna Smith“My Patients Are Sicker”…Prove it! Cheryl ManchentonDocumentation Quality: Time to Line up the Ducks Jill Devrick	Making Data ActionableTaking a Closer Look at the June ICD-10 Coding Challenge Sue BelleyOPPS Proposed Rule for 2016 Dave FeePhysicians and Coders: No More Unspecified Care Barbara Aubry	Blog at WordPress.com.