Updated on: March 17, 2016

Uncovering GEM Issues Akin to Finding New Planets or Comet

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Original story posted on: September 20, 2013

When I first met him, a talkative and enthusiastic Alan Hale seemed as regular a guy as could be. He recently had discovered what he reportedly described as a “fuzzy object” while exploring the universe with his telescope in the driveway of his New Mexico home.

His discovery was the Comet Hale-Bopp.

 

Until his 1995 discovery, corroborated with a sighting by Thomas Bopp, much of the world knew of but one comet, “Halley’s,” last seen in 1986. Astronomers predict its reappearance will occur in 2061, when ICD-10 will be the faintest of faint memories — an arcane footnote of a medical artifact.

But Hale comes to mind when discussing general equivalence mappings (GEMs) with healthcare consultant Mandy Willis, an otherwise regular person, who is, however, steeped in ICD-10. Coincidently, Willis recently discovered (as others have) what she described as “issues” with GEMs.

“As I’m not a clinician, I looked for issues that were in the mapping themselves, such as inconsistencies in the assignment of an “approximate” indicator versus identifying a mapping as an “exact match,” Willis told ICD10monitor in a written statement. “I also looked for issues that contradicted the ICD-9/ICD-10 guidelines, such as mappings that included codes that would be considered excluded.”

Like Hale and Bopp searching the skies, coders, physicians and other healthcare professionals have uncovered these issues by going through the GEMs and reviewing the mappings.

“The Workgroup for Electronic Data Interchange (WEDI) established the ICD-10 clinical sub-workgroup (SWG), which coordinated efforts among the WEDI members who were interested in doing this review,” wrote Willis, who serves as one of the WEDI ICD-10 coding and translations sub-workgroup co-chairs. “I participated in developing the process, facilitating reviews of the issues as well as documentation of the issues and submission to CMS (the Centers for Medicare & Medicaid Services) through WEDI.”

Back on May 19, 2009, Pat Brooks, senior technical advisor at CMS, explained the GEMs concept during a national provider conference call.

“GEMs — these mappings — are a useful tool, and they'll help you convert large data sets,” Brooks told attendees. “However, they won't be a substitute for learning how to code with ICD-10. Starting about six months ahead of implementation or a little shorter, you should have a plan to begin learning seriously how to use ICD-10.”

Willis said the first release of the GEMs was set for 2010, and that was when the ICD-10 Clinical SWG started reviewing them. Since then, there have been subsequent releases by CMS.

“The ICD-10 clinical SWG would meet on a regular basis to review mapping issues that had been identified,” Willis noted. “There would be discussions on what the issue was and if it was an truly an issue or an artifact of the translation process itself.”

Willis explained that once it was determined there was an issue that could be remedied, it would be documented in a spreadsheet, along with an example of the issue and a suggested action. The issues were forwarded to CMS for review during the biannual ICD-9/ICD-10 public commentary periods.

“We submitted the issues we uncovered to CMS on three occasions,” Willis wrote. “Our last full review and submission of issues was in 2012. After 2012, the identification of issues really slowed down. Hopefully that is because there aren’t any more!”

In the meantime, back to the universe at large, when on April 18, 2013, NASA scientists made the unlikely discovery of three distant planets very much resembling the Earth – all of which experts believe could be “habitable.” What are the chances of coders, physicians and consultants such as Willis discovering other GEM issues between now and October 2014, the mandatory compliance date for ICD-10?

“The good news is that, with the last release of the GEMs, almost all of the issues that had been identified by the WEDI ICD-10 clinical SWG were remedied,” Willis wrote. “To put it into perspective, out of the 75,000+ mappings in ICD-10 diagnosis codes, the Clinical SWG only identified 47.”

 


 

Willis said that many organizations have combed through the GEMs in an effort to develop their own mappings, although she admits there is a chance that more issues will be identified as more organizations begin to do the work of translation.

“Be aware that the GEMs, like the code sets, have been updated annually, and not to simply reflect the addition or deletion of codes,” Willis wrote. “The GEMs were open for public comment since their release, and as organizations and professionals have had an opportunity to weigh in on the clinical appropriateness and/or coding accuracy of the mappings, the GEMs have been revised.”

As a cautionary measure, Willis said that if a vendor previously used an earlier release of the GEMs and claimed its application/software was ICD-10-ready, it may want to go back and perform a quality check to make sure it has the most current mappings in place.

“Vendors may also need to have access to clinical and/or coding resources that are proficient in ICD-10 in order to either identify future issues or help to mitigate issues that might be uncovered moving down the translation path,” Willis wrote.

“However, this requires people who are looking at the mappings from a clinical and coding perspective,” Willis added. “If an organization isn’t using people with clinical and coding expertise, then issues may not be uncovered. I think, overall, most of the issues have been identified, though.”

So much for new discoveries.

 

Resources:

2014 GEMs FY 2014 Version Update

Examples: GEMs Issues

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Chuck Buck

Chuck Buck is the publisher of ICD10monitor and is the executive producer and program host of Talk Ten Tuesdays.