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February 20, 2012

“To Use GEMs, or not to Use GEMs?”


“To use GEMs, or not to use GEMs?” That is a question posed by many ICD-10-minded people these days. To address this issue, let’s take a look at what GEMs are not. Experts are recommending that GEMs not be used as a primary coding resource or used to code current claims, and the experts are correct. GEMs should not replace your ICD-9-CM code books and encoders. The final ICD-10-CM code set has yet to be determined. Since the codes are not final and the CMS database has not been perfected, using GEMs as a coding reference is premature.

But here is what GEMs can do for you. Simply stated, top experts agree that GEMs are among the best ICD-10 educational tools available today. Enhanced GEMs software solutions provide cost-effective ICD-10 training that creates immediate staff and provider awareness.

Engaging providers in sweeping, mission-critical change is always a challenge. For ICD-10, providers and practice administrators know they need to get started on the transition, but many have no idea how to begin the conversation. An affordable (cheaper than the cost of code books), automated GEMs tool is the perfect way to initiate the process. Putting this easy-to-use software in the hands of everyone – from the billing clerk who barely deals with diagnoses to the most experienced provider and coder – is a great way to kick-start the ICD-10-CM transition.

Why is this? A GEMs translator can be used to illustrate the structural differences between digital ICD-9 codes and alphanumeric ICD-10 codes for your most frequently captured diagnoses. GEMs can demonstrate the dramatic difference in specificity between the code sets and the need to capture laterality, degree of severity or healing and encounter type under ICD-10. GEMs can be used to create side-by-side contrasts illustrating ICD-10 documentation needs compared to those required for ICD-9.

Offering this immediate visual representation of the increased detail required for documentation, charting and coding is an excellent way to engage everyone affected.

Please note that we are not referring to the free online versions that provide limited “one-code-lookup” functionality. Rather, we are suggesting a tool that provides multiple bi-directional searches by code or code description, and one that has a print function to create quick reference guides and a storage capability to warehouse the most frequently used diagnoses.

Saving precious time that most practices can’t currently spare may be the most valuable GEMs benefit. The crystal ball says that within the next six months, providers at practices finally beginning the ICD-10 journey will be asking their staff to “translate” most frequently used ICD-9 codes so those practices can become familiar with the new coding and documentation conventions. Imagine having to use code books to convert two ICD-9-CM patella fracture codes to 480 ICD-10-CM codes. This could take hours. Using a suitable GEMs tool, it takes seconds.



Everywhere a diagnosis code touches your practice, there exists paper/technology and human impact. For example, superbill and EMR chart note templates require ICD-10 conversion. All order entry (lab, X-ray, PT, OT, DME) requires ICD-10 translation. Pre-authorization of insurance is something that needs to be addressed, as are referrals to outside providers. Do not minimize the human element in these impact areas. Converting to ICD-10 using GEMs fosters familiarity for every staff member, no matter how peripheral. Plus, early awareness breeds comfort. Ultimately, the goal is to implement cost-effective training. Beginning that process now gives any practice a leg up when coding training begins.

Using GEMs to perform chart audits that gauge your current documentation’s ability to support specific ICD-10 codes is easy. Again, you could use ICD-9-CM and draft ICD-10 code books to accomplish these conversions. But why would you when there are fully functional GEMs alternatives on the market that cost less than a diagnosis code book set – tools that could save hours of valuable time and ultimately reduce the stress and strain on your staff?

Using a print-capable GEMs tool to create quick reference documentation and coding guidelines is a snap. Again, imagine how long it would take to create a documentation comparison table manually using code books. Using a printable GEMs resource allows you to print custom flash cards for codes, descriptions and new documentation requirements instantly rather than engaging in the time-consuming task of entering dozens of codes and code descriptions by hand.

Again, according to the experts, GEMs may not be a reference from which you currently can code claims. However, it is the most cost-effective resource available to educate, train and create awareness among staff and providers regarding ICD-10-CM’s dramatic projected impact.

Your job is about to get a lot harder. But taking advantage of the right GEMs tool definitely can help.

About the Author

Denny Flint is president of Complete Practice Resources. Denny formerly served as the CEO of a large, multi-specialty physician group, a full service MSO and was a certified professional coder through AAPC. He has authored or co-authored numerous “common sense” practice management books and implementation manuals. Educated at the United States Air Force Academy, he had a distinguished career as an Air Force pilot flying numerous secret and sensitive missions.

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Read 19 times Updated on September 23, 2013
Denny Flint

Denny is the chief executive officer of Complete Practice Resources, a healthcare education, consulting, and software company headquartered in Slidell, Louisiana. He formerly served as the CEO of a large, multi-specialty physician group, full service MSO. Denny has authored or co-authored numerous “common sense” practice management books and implementation manuals. He is an award winning, nationally known consultant, speaker, and educator bringing his expertise to making the complex “simple.” He currently serves on the editorial board of ICD10 Monitor. Educated at the United States Air Force Academy, Denny had a distinguished career as an Air Force pilot and has a long history of commitment to excellence and dedication to his clients’ success.

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