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Preparing for ICD-10-CM/PCS: one payer's experience with general equivalence mappings (GEMs)
1Blue Cross and Blue Shield of Illinois, Chicago, IL, USA.
Perspectives in Health Information Management
|May 2, 2012
Summary
The Health Care Service Corporation (HCSC) used bidirectional General Equivalent Mappings (GEMs) to transition from ICD-9-CM to ICD-10-CM/PCS. This analysis details practical lessons learned from applying GEMs for business rule translation during the ICD-10-CM/PCS implementation.
Area of Science:
- Health Informatics
- Medical Coding Systems
- Healthcare Administration
Background:
- The United States mandated the transition from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to International Classification of Diseases, Tenth Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) effective October 1, 2013.
- This transition aimed to enhance the specificity and detail of medical coding for improved healthcare data analysis and reporting.
- The National Center for Health Statistics developed bidirectional General Equivalent Mappings (GEMs) to facilitate the migration from ICD-9-CM to ICD-10-CM/PCS.
Purpose of the Study:
- To evaluate the practical application of GEMs by Health Care Service Corporation (HCSC) in their transition to ICD-10-CM/PCS.
- To identify challenges and lessons learned during the translation of business rules and processes using GEMs.
- To provide insights into data issues encountered during the ICD-9-CM to ICD-10-CM/PCS transition from a payer's perspective.
Main Methods:
- Analysis of HCSC's practical application of GEMs for ICD-10-CM/PCS transition.
- Examination of questions raised during the implementation process.
- Review of lessons learned in translating business rules and processes using GEMs.
Main Results:
- Successful leveraging of GEMs by HCSC to facilitate the transition to ICD-10-CM/PCS.
- Identification of specific data issues and challenges encountered in practical GEMs application.
- Gained understanding of the complexities in translating existing business rules to the new ICD-10-CM/PCS code set.
Conclusions:
- GEMs are a valuable tool for navigating the transition from ICD-9-CM to ICD-10-CM/PCS.
- Practical application of GEMs requires careful consideration of business rules and data intricacies.
- The payer's perspective is crucial for understanding and addressing data challenges during major coding system transitions.
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