{"id":4890,"date":"2011-05-31T12:08:31","date_gmt":"2011-05-31T12:08:31","guid":{"rendered":"https:\/\/www.varshabi.com\/HCIM2\/?p=4890"},"modified":"2021-04-15T15:37:05","modified_gmt":"2021-04-15T15:37:05","slug":"icd-10-myth-buster-gems-provide-simple-one-to-one-reimbursement-mappings","status":"publish","type":"post","link":"https:\/\/www.varshabi.com\/HCIM2\/icd-10-myth-buster-gems-provide-simple-one-to-one-reimbursement-mappings\/","title":{"rendered":"ICD-10 Myth Buster: Do GEMs provide simple one-to-one Reimbursement Mappings?"},"content":{"rendered":"

NCHS and CMS have published General Equivalency Mappings (GEMs) as a translation reference between I-10 and I-9 diagnosis and procedure codes. These “one-to-one” mappings translate one I-10 code to either one I-9 code or one cluster<\/em> of up to six ICD-9 codes. This is why the mappings are referred to as both one-to-one and one-to-many.<\/p>\n

I-9 Code Clusters<\/h3>\n

In some cases it takes as many as six I-9 codes combined (clustered) to reproduce one I-10 code. According to CMS, “This is the case with I-9 principal procedure codes such as coronary angioplasty that require the use of ‘adjunct’ I-9 codes to provide additional detail.”<\/p>\n\n\n\n\n\n
I-10 Procedure<\/strong><\/td>\nCorresponding I-9 Procedures<\/strong><\/td>\n<\/tr>\n
02733ZZ: Dilation of Coronary Artery, Four or More Sites, Percutaneous Approach<\/td>\n00.66: PTCA or coronary atherectomy<\/td>\n<\/tr>\n
00.43: Procedure on four or more vessels<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

If the procedure was performed on four or more vessels, the “adjunct” 00.43 I-9 code must be applied in addition to 00.66 because some reimbursement systems may pay more for a procedure performed on four or more vessels.<\/p>\n

I-9 Code Alternatives<\/h3>\n

According to CMS, “More than one I-9 code may be a valid translation of a given I-10 code. Which one of those I-9 codes is the most correct translation cannot be determined based on the meaning of the codes themselves.”<\/p>\n\n\n\n\n\n
I-10 Procedure<\/strong><\/td>\nCorresponding I-9 Procedures<\/strong><\/td>\n<\/tr>\n
0LQ70ZZ: Repair Right Hand Tendon, Open Approach<\/td>\n83.61: Suture of tendon sheath<\/td>\n<\/tr>\n
83.64: Other suture of tendon<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

ICD-10 Reimbursement Mapping*
\nDistribution of mappings to single I-9 codes and I-9 code clusters<\/h3>\n\n\n\n\n\n
Code set<\/strong><\/td>\nMapped to single
\nI-9 code<\/strong><\/td>\n		Mapped to 2-code cluster<\/strong><\/td>\nMapped to 3-code cluster<\/strong><\/td>\nMapped to 4-code cluster<\/strong><\/td>\nMapped to 5-code cluster<\/strong><\/td>\nMapped to 6-code cluster<\/strong><\/td>\nTotal
\nI-10 codes<\/strong><\/td>\n<\/tr>\n
ICD-10-CM (diagnosis)<\/strong><\/td>\n65,767<\/td>\n3,302<\/td>\n26<\/td>\n6<\/td>\n0<\/td>\n0<\/td>\n69,101<\/td>\n<\/tr>\n
ICD-10-PCS (procedure)<\/strong><\/td>\n69,657<\/td>\n1,211<\/td>\n583<\/td>\n458<\/td>\n36<\/td>\n12<\/td>\n71,957<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

For more information on the ICD-10 code impacts, complete the contact form located on the sidebar.<\/p>\n

*Download CMS’ ICD-10-CM\/PCS to ICD-9-CM Reimbursement Mappings 2010 Version Documentation and User’s Guide<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

NCHS and CMS have published General Equivalency Mappings (GEMs) as a translation reference between I-10 and I-9 diagnosis and procedure codes. These “one-to-one” mappings translate one I-10 code to either one I-9 code or one cluster of up to six ICD-9 codes. This is why the mappings are referred to as both one-to-one and one-to-many. I-9 Code Clusters In […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,18],"tags":[38,36,32],"class_list":["post-4890","post","type-post","status-publish","format-standard","hentry","category-healthcare-information-management","category-archive","tag-blog","tag-hcim-clients","tag-technology"],"_links":{"self":[{"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/posts\/4890","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/comments?post=4890"}],"version-history":[{"count":2,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/posts\/4890\/revisions"}],"predecessor-version":[{"id":16814,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/posts\/4890\/revisions\/16814"}],"wp:attachment":[{"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/media?parent=4890"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/categories?post=4890"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.varshabi.com\/HCIM2\/wp-json\/wp\/v2\/tags?post=4890"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}