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Thread: ICD-10 Payer Mapping and GEM's

  1. #1
    Join Date
    Apr 2007
    Burlington, Vermont

    Default ICD-10 Payer Mapping and GEM's

    AAPC: Back to School
    Hey, I am looking to speak to other coders who are working on creating maps for insurance companies of ICD-10 codes from ICD-9 codes. I am interested in having discussions about what you think about the GEM's mappings, and how you are mitigating the poor mapping that the GEM's puts fourth. When we as coders are asked to create a map and we have no clinical documentation to go from.

    I am finding that as I create the initial maps I have to include a lot of codes. What is everyone else doing?


  2. #2
    Join Date
    Apr 2007
    Dover Seacoast New Hampshire


    As you know, a single ICD-9 does not always map to a single ICD-10 code, unless you want to provide yourself with a huge list of unspecified codes. You can use the GEMS as a start, but you have to look at I-10 and determine which codes are going to now fill into the "other specified" categories of ICD-9. The GEMS won't give you that detail. Additionally, the I-10 codes specify laterality, meaning there's at least two additional codes for each I-9.

    I am not working for a payer, but I am doing analysis of our EMR's documentation ability to meet the expanded ICD-10 criteria, and it's one whopping project.

    Job security.....
    Pam Brooks, MHA, CPC, PCS, COC
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

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