Surviving the ICD-10 Transition: General Equivalence Mappings aren’t enough

Do you feel uneasy about the ICD-10 Transition?

More than half of the practices we work with dismiss the magnitude of the ICD-10 transition. Most have proposed their intent to rely solely on General Equivalence Mapping (GEMs). These are the same practices that become shocked to discover their pre-conceived “plan” to simplify the ICD-10 transition will only cause more problems.

For those of you who are unfamiliar with general equivalence mapping (GEMs), GEMs files were developed as a tool to easily translate codes to and from ICD-9-CM and ICD-10-CM. If this sounds too good to be true, that’s because it is! Because of the specificity of ICD-10, it is not possible to have a one-to-one crosswalk for many codes.

1:1 Mapping isn’t quite that simple

There are quite a few ICD-9 and ICD-10 codes whose translation is very straightforward and easy to match one with another. These are referred to as “one-to-one” (1:1) matches. However, a 1:1 match does not necessarily mean the two codes are identical, it simply means there is only one alternative. More often, one ICD-9 code can translate into several ICD-10 codes, which is where your issues will begin.

Let’s look at an example which may help you understand how disastrous relying solely on GEMs can be:

ICD-9 Code: 729.5 – Pain in limb
Maps to
ICD-10 Code: M79.609 – Pain in unspecified limb

ICD-9 code 729.5 has mapped to an unspecified ICD-10 code but, there are more specific code choice selections in ICD-10. Let’s take a deeper look.

M79.601 – Pain in right arm
M79.602 – Pain in left arm
M79.603 – Pain in arm, unspecified
M79.604 – Pain in right leg
M79.605 – Pain in left leg
M79.606 – Pain in leg, unspecified
M79.621 – Pain in right upper arm……and so on

Solely utilizing GEMs as a solution to the overwhelming and laborious process of ICD-10 implementation will only prevent you from accomplishing a successful transition to ICD-10 and in turn, cost your practice more money. Don’t make the mistake of underestimating what it will take to achieve a successful transition or the benefits you will reap for it. Although on the surface the transition to ICD-10 appears to be laborious and overwhelming, the advantages far outweigh the costs.

Are you curious about the business processes and technology touch points that will affect your organization during the implementation of the ICD-10 code sets?