ICD-10 GEMs FY2012 Version Update
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1 ICD-10 GEMs FY2012 Version Update Update Summary Updated FY2012 GEMs to be Posted The updated FY2012 General Equivalence Mappings (GEMs) will be posted for public comment in early October 2011 for procedure codes and early December 2011 for diagnosis codes. Both will be posted on the CMS website along with GEMs User Guide and Documentation for Technical Users, at The diagnosis GEMs are also posted on the CDC website at All changes to date resulting from public comment and internal review have been incorporated into the FY2012 GEMs. The types of comments received include Suggested additional translation alternatives based on inclusion criteria (e.g., the same clinical term occurred in the index for both ICD-9 and ICD-10) Requested a new cluster translation for completeness Reported exact match flag inconsistencies Recommended deleting entries that do not meet inclusion criteria All changes meeting inclusion criteria were made for the FY2012 update. Review and testing of all entries containing the exact match flag was undertaken to ensure that all such entries meet the strict criteria for exact match as defined in the GEMs Documentation for Technical Users. Updated documentation for general and technical users of the GEMs will be posted with the GEMs files. The GEMs Documentation for Technical Users Specifies GEMs entry inclusion criteria and provides examples Discusses GEMs flags in detail and provides examples Answers other frequently asked technical questions Discusses translation rules for obstetrics and angioplasty s of updated GEMs entries for FY2012 are provided in the following pages. ICD-10-CM to ICD-9-CM GEM entry for NASH code K75.81 Nonalcoholic steatohepatitis (NASH) K75.81 Nonalcoholic steatohepatitis (NASH) To Hepatitis, To Other chronic nonalcoholic liver disease Hepatitis, Although the available ICD-9- CM index and tabular instruction are not explicit as to ICD-9-CM coding for NASH, adding another approximate 10 to 9 GEMs translation meets inclusion criteria. The existing translation to is also approximate. 1
2 ICD-9-CM to ICD-10-PCS GEM entry for radical laryngectomy code Scenario Radical laryngectomy Scenario Radical laryngectomy To 0CTS[0,4,7,8]ZZ Resection of Larynx (4 codes) To 0WB6[0,3,4,X]ZZ Excision of Neck Region (4 codes) To 0CTS[0,4,7,8]ZZ Resection of Larynx (4 codes To 07T[1,2][0,4]ZZ Resection of Neck Lymphatic (4 codes) Diagnosis GEM entries (both files) for CNS complication code The neck dissection portion of the PCS cluster translation of ICD-9-CM code 30.4 Radical laryngectomy has been modified to match the translation of ICD- 9-CM radical neck dissection code Radical neck dissection, not otherwise specified, for consistency ICD-9-CM GEM Central nervous system complication ICD-9-CM GEM Central nervous system complication To G97.2 Intracranial hypotension following ventricular shunting To G97.81 Other intraoperative complications of nervous system To G97.82 Other postprocedural complications and disorders of nervous system The current translation of the ICD-9-CM code does not meet inclusion criteria. The target system code translation contains more information than that contained in the source system code. The updated entry contains two ICD-10- CM alternatives that meet inclusion criteria. Diagnosis GEM entries (both files) for abnormal findings code R79.89 Other specified abnormal findings of blood chemistry R79.89 Other specified abnormal findings of blood chemistry To Other nonspecific findings on examination of blood To Other abnormal blood chemistry Other nonspecific findings on examination of blood Meets inclusion criteria for additional approximate translation alternative. 2
3 ICD-9-CM to ICD-10-PCS GEM entry for limb lengthening procedure code Scenario Limb lengthening procedures, other bones Scenario Limb lengthening procedures, other bones 0P8T0ZZ Division of Right Finger Phalanx, Open 0P8T3ZZ Division of Right 0P8T4ZZ Division of Right Endoscopic 0PUT07Z Supplement Right Autologous Tissue Substitute, Open 0PUT0KZ Supplement Right Substitute, Open 0PUT37Z Supplement Right Autologous Tissue Substitute, Percutaneous 0PUT3KZ Supplement Right 0PUT47Z Supplement Right Autologous Tissue Substitute, Percutaneous Endoscopic 0PUT4KZ Supplement Right Endoscopic 0P8T0ZZ Division of Right Finger Phalanx, Open 0P8T3ZZ Division of Right 0P8T4ZZ Division of Right Endoscopic 0PUT07Z Supplement Right Autologous Tissue Substitute, Open 0PUT0KZ Supplement Right Substitute, Open 0PUT37Z Supplement Right Autologous Tissue Substitute, Percutaneous 0PUT3KZ Supplement Right 0PUT47Z Supplement Right Autologous Tissue Substitute, Percutaneous Endoscopic 0PUT4KZ Supplement Right Endoscopic Typographical error. The number of scenarios in a combination entry was streamlined in the previous update and the scenario numbers were not reset to begin with scenario 1. The scenario numbers have been updated to reflect the change. 3
4 ICD-9-CM to ICD-10-PCS GEM entry for endoscopic polypectomy code [Endoscopic] polypectomy of rectum [Endoscopic] polypectomy of rectum To 0DBP8ZZ Excision of Rectum, Via Natural or Artificial Opening Endoscopic To 0DBP8ZZ Excision of Rectum, Via Natural or Artificial Opening Endoscopic Typographical error. The entry is a single entry and the last flag is only used for combination entries. The flag was changed to zero. FLAGS: Diagnosis GEM entries (both files) for chronic ischemic heart disease NEC code ICD-9-CM GEM Other specified forms of chronic ischemic heart disease ICD-9-CM GEM Other specified forms of chronic ischemic heart disease To I25.6 Silent myocardial ischemia I25.89 Other forms of chronic ischemic heart disease To I25.6 Silent myocardial ischemia I25.89 Other forms of chronic ischemic heart disease I25.9 Chronic ischemic heart disease, and I25.9 both contain the index entry Ischemia, ischemic > myocardium, myocardial (chronic or with a stated duration of over 8 weeks) Therefore, meets inclusion criteria for additional approximate translation alternative in both diagnosis GEM files. ICD-10-CM to ICD-9-CM GEM entry for ventricular premature polarization code I49.3 Ventricular premature depolarization I49.3 Ventricular premature depolarization To Paroxysmal ventricular tachycardia To Other premature beats Typographical error. The recommended translation meets inclusion criteria according to the index entries for both ICD-9-CM and ICD-10-CM, for example, Tachycardia > supraventricular 4
5 Diagnosis GEM entries (both files) for exact match flag ICD-9-CM GEM Ancylostomiasis and necatoriasis, ICD-9-CM GEM Ancylostomiasis and necatoriasis, To B76.8 Other hookworm diseases B76.9 Hookworm disease, FLAGS: To B76.8 Other hookworm diseases B76.9 Hookworm disease, As a result of numerous public comments received in 2010 and incorporated in the 2011 update, additional translation alternatives were added at the 2011 update to entries flagged as an exact match. Such entries no longer meet the exact match definition as clarified in the GEMs technical documentation. The flags have been revised to an approximate match for the 2012 update. ICD-10-CM to ICD-9-CM GEM entry for Diabetes with hypoglycemia and coma E Diabetes mellitus due to underlying condition with hypoglycemia with coma ICD-9-CM GEM E Diabetes mellitus due to underlying condition with hypoglycemia with coma To Secondary diabetes To Secondary diabetes Secondary diabetes To Secondary diabetes Typographical error. A combination entry was listed that contained redundant translations of the single translation in both choice lists. The unnecessary entry was removed for the 2012 update. 5
6 Internal review: ICD-9-CM to ICD-10-CM GEM entries for fracture of tibia with fibula codes Closed fracture of part of fibula with tibia Scenario Closed fracture of part of fibula with tibia To S82.91xA Unspecified fracture of right lower leg, initial encounter for closed fracture S82.92xA Unspecified fracture of left lower leg, initial encounter S82.201A Unspecified fracture of shaft of right tibia, initial encounter S82.401A Unspecified fracture of shaft of right fibula, initial encounter Scenario Closed fracture of part of fibula with tibia S82.202A Unspecified fracture of shaft of left tibia, initial encounter S82.402A Unspecified fracture of shaft of left fibula, initial encounter According to the ICD-10-CM index, fracture site defaults to shaft, so an ICD-10-CM combination entry containing fracture of tibia shaft and fibula shaft is a better translation of the source system ICD-9-CM code. Internal review: Diagnosis GEM entries (both files) for nervous system complication code ICD-9-CM GEM Other nervous system complications ICD-9-CM GEM Other nervous system complications To G97.0 Cerebrospinal fluid leak from spinal puncture G97.81 Other intraoperative complications of nervous system G97.82 Other postprocedural complications and disorders of nervous system To G03.8 Meningitis due to other specified causes G97.0 Cerebrospinal fluid leak from spinal puncture G97.81 Other intraoperative complications of nervous system G97.82 Other postprocedural complications and disorders of nervous system Similar index entries in both code sets indicate that postprocedural meningitis is included in the complete meaning of the code, as in the example: Meningitis (basal) (basic) (basilar) (brain) (cerebral) (cervical) (congestive) (diffuse) (hemorrhagic) (infantile) (membranous) (metastatic) (nonspecific) (pontine) (progressive) (simple) (spinal) (subacute) (sympathetica) (toxic) > due to > preventive immunization, inoculation, or vaccination 6
7 Internal review: Diagnosis GEM entries (both files) for primary insomnia code ICD-10-CM GEM ICD-10-CM GEM Typographical error. F51.01 Primary insomnia F51.01 Primary insomnia To Confusional arousals F51.02 Adjustment insomnia To REM sleep behavior disorder To Persistent disorder of initiating or maintaining sleep F51.02 Adjustment insomnia To Transient disorder of initiating or maintaining sleep Internal review: ICD-9-CM to ICD-10-PCS GEM entries for fistula repair codes Closure of other fistula of thorax Scenario Closure of other fistula of thorax To 0WQ[8,C][0,3,4]ZZ (6 codes) Repair of Chest Wall or Mediastinum To 0BQ[3-B][03478]ZZ (40 codes) 0BQ30ZZ Repair of Bronchus 0DQW[034]ZZ (3 codes) Repair of Peritoneum In previous GEMs releases, translation of ICD-9-CM codes for repair of fistula were listed as single entries, specifying the deepest anatomical site of the repair in the ICD-10-PCS translation. Upon review it was determined that a complete translation should be an ICD-10-PCS combination entry containing ICD-10-PCS repair codes specifying both body parts involved in the fistula. 7
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