ICD- 10 Mapping
2012 GEM Statistics per CMS
Mapping Direction
ICD- 9 Code Type - Diagnosis
Mapping Types
Exact Map
Approximate Map
Combination
No Map
Foward Map
Code Count of Total
14567 100.00%
3533 24.25%
9964 68.40%
645 4.43%
425 2.92%
Backward Map
Code Count of Total
69833 100.00%
3533 5.06%
61820 88.53%
3811 5.46%
669 0.96%
Procedure Code Sets
Mapping Direction
ICD- 9 Code Type - Procedure
Mapping Types
Exact Map
Approximate Map
Combination
No Map
Foward Map
Code Count of Total
3877 100.00%
47
1.21%
3409 87.93%
211 5.44%
210 5.42%
Backward Map
Code Count of Total
71918 100.00%
47 0.07%
69800 97.05%
2071 2.88%
0 0.00%
that comply with logic based on ICD- 9. Next, perform an in-depth analysis of the proposed implementation plans across
the identified business functions and systems (covering all tangential elements) to specify the need to invoke a map or a type
of map for supporting those business operations and systems.
It’s important to note that there are many instances where
maps are not fitting or useful. Organizations should not depend
on maps for ongoing use in transactions. When there is a justified need to link one code set to another, it is usually for data
trending or analysis, not for active code designation.
Business functions can include:
x Product/benefit groups
x Clinical policy
x Claims adjudication
x Authorization and utilization management
x Care management and member stratification
x Claims pricing and provider reimbursement
x HIM—coding and DRG assignment
x Clinical documentation
x Contracting and reimbursement modeling
x Quality reporting
CMS GEMs. Stakeholders from various business domains and
lines of business will need to provide required business inputs
and validate the intent of the created maps. For example, busi-
ness domain stakeholders can be from medical policy, benefit
configuration, contracting, case management, claims, HIM, uti-
lization review, and clinical documentation among others,
whereas line-of-business stakeholders can be drawn from
Medicare, health maintenance organizations (HMOs), and oth-
er similar organizations. Creating this mix ensures genuine
cross-functional collaboration.
Some of the criteria that can be used to identify the ICD- 9 codes
for mapping include:
x Codes present in high volumes across transactions
x Codes associated with high-dollar reimbursements
x Unique codes involved in critical business rules across
functions and lines of business
x Codes associated with various contracts, critical diagno-
sis related groups (DRGs), and risk adjustments
x Codes critical from an actuarial, underwriting, and infor-
matics/reporting standpoint
This core mapping team must consist of skilled resources, in-
cluding coders who are knowledgeable in ICD- 10 codes and
Based on their GEM relationship, the identified ICD- 9 codes
can be further segregated into categories with respect to de-
