Journal of AHIMA - May 2012

2012 ICD-9-CM to ICD-10-PCS GEM for 22. 39

POTENTIAL MAPPING OPTIONS in ICD-10-PCS for a Caldwell-luc procedure.

Source: ICD-9-CM

2239

Target: ICD-10-PCS

099Q00Z

099Q0ZZ

099R00Z

099R0ZZ

09CQ0ZZ

09CQ3ZZ

09CQ4ZZ

09CR0ZZ

09CR3ZZ

09CR4ZZ

GEM Flags

10000

x What are the circumstances for partially automating the development of an applied mapping?

The GEMs are also useful in more simple applications within the organization. Coders, clinical documentation improvement specialists, and others may utilize the GEMs to translate a familiar ICD-9-CM code in situations where they may not be sure of the correct code in ICD-10-CM/PCS. Using the GEMs, the individual will be able to ascertain if the code they have selected in ICD-10-CM or ICD-10-PCS is a reasonable choice.

For example, 22. 39 is the ICD-9-CM procedure code for a Caldwell-Luc operation. A user of ICD-10-PCS may elect to use the ICD-9-CM to PCS GEM mapping to identify codes in ICD- 10-PCS if the user is unsure of the correct root operation that applies. The user can apply the information supplied in the GEM to assist in determining which table (099 – Ear, Nose, Throat, Drainage, or 09C – Ear, Nose, Throat – Extirpation) best fits the procedure described in the documentation (see Figure 1).

The GEMs were developed to serve a specific limited, short-term need—to allow the industry to migrate systems, applications, and data from ICD-9-CM to ICD-10-CM/PCS. They are intended to be used primarily for translations of code lists or code tables, used by an application or other coded data, when codes in one set are the only source of information.

The GEMs are not intended to be a substitute for using ICD-
9-CM and ICD-10-CM/PCS directly. The code sets should be
used to look up the applicable codes if the health record or the
clinical terms describing a diagnosis or procedure are avail-
able. The GEMs should not be considered as a “crosswalk” be-
tween the two code systems, nor should they be viewed as a
replacement for the necessary training in both ICD-10-CM and
ICD-10-PCS. ¢

References

Bowman, Sue, and Ann Zeisset. ICD-10-CM/PCS Transition: Planning and Preparation Checklist. Chicago: AHIMA Press, 2011.

Centers for Medicare and Medicaid Services. “2012 ICD- 10-PCS and GEMs.” December 5, 2011. www.cms.gov/ ICD10/ 11b15_2012_ICD10PCS.asp.

Giannangelo, Kathy. Transitioning to ICD-10-CM/PCS. Chicago: AHIMA Press, 2011.

Theresa Rihanek ( theresa.rhianek@ahima.org) and Kathy DeVault (kath- ryn.devault@ahima.org) are directors of professional practice at AHIMA.

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