GEMs Files Bow Out for 2019
If you’re one of the medical coders who has been looking forward to perusing the 2019 GEMs files, you’re going to be pretty disappointed. The GEMs files have seen their day.
GEMs Sunset Planned
The GEMs file was developed as a crosswalk between ICD-9-CM and ICD-10-CM during preparation for ICD-10-CM’s implementation. Used by many as a training tool, the file revealed that while thousands of ICD-9-CM codes exploded into many more, highly specific ICD-10-CM codes, many had no direct link. Medical coders and payers used the file to help learn the new code set and determine how to use new codes.
They became even more important when the Centers for Medicare & Medicaid Services (CMS) allowed dual coding during ICD-10-CM’s maiden year as the official code set. From 2015 through September 30th, 2016 GEMS helped coders report both code sets.
CMS saw no need for the file after the transition, though. The files were updated through the 2018 coding year, but claim denial repeals for the first ICD-10-CM year were resolved, and providers and payers covered by HIPAA had nearly forgotten the code set.
CMS announced the GEMS file’s demise in the fiscal year 2016 Inpatient Prospective Payment final rule (80 FR 49388), and reiterated at the September 2017 ICD-10 Coordination and Maintenance Committee. Officially, the GEMs file was updated on an annual basis as part of the ICD-10 Coordination and Maintenance Committee meetings process.
So bid farewell to the GEMs files. While they are gone, many organizations will still offer the 2018 set for those still interested in finding the links between both codes sets.