Expedite ICD-10-CM/PCS Mapping Decisions with the HLI GEMs+ Conversion Solution
The GEMs mappings provided by the Centers for Medicare and Medicaid Services (CMS) offer a starting place for healthcare organizations transitioning to ICD-10-CM/PCS. While useful, there are instances where these mappings are inconsistent, inaccurate, or unavailable for specific ICD-9-CM or ICD-10-CM/PCS codes. HLI created the GEMs+ Content Set to provide mapping decision-support tools for circumstances where the GEMs mappings fall short.
The GEMs+ Conversion Solution includes:
- Provider Friendly Terminology to expedite searches for specific clinical concepts
- ICD-10-CM Attribute Definitions to ensure coding specificity in provider contracts, benefit plans, and medical policies
- Coding Guidelines and Instructional Notes to identify codes for consideration or exclusion
- LEAP I-10 Analytics to identify alternate ICD-10-CM to ICD-9-CM maps based on actual claims data analysis. By using your specific plan data to determine frequencies of codes, HLI can recommend alternate maps that may differ from the CMS GEMS and Reimbursement maps.
The HLI Provider Friendly Terminology (PFT) content set includes over 200,000 synonyms, colloquial expressions, abbreviations, tabular index entries, and other clinical concepts familiar to coders and care providers. These terms are linked to standards, including ICD-9-CM, ICD-10-CM/PCS, and SNOMED CT, enabling clinicians to maintain their productivity without having to adjust to evolving standards and content updates.
The PFT library of terms is created and maintained by the HLI team of certified ICD-10-CM coders, physicians, and nurses to ensure clinical accuracy. The terms are based on coding guidelines and allow users to easily retrieve ICD-9-CM or ICD-10-CM codes for mapping consideration.
The HLI ICD-10-CM Attribute Definitions specify the type of information that must be gathered (e.g. gender, laterality, severity) in order to select a billable ICD-10-CM code. HLI uses a combination of automated ontology tools and manual professional coding expertise to identify these attributes. These definitions enable payers to increase clinical documentation requirements for claims and conduct meaningful outcomes research. In addition, by identifying base ICD-10-CM codes distinct from the underlying attributes, the LEAP I-10 tool facilitates identifying additional codes to consider including in maps or medical policies for example.
The LEAP I-10 tool includes CMS coding guidelines and instructional notes to automatically identify additional codes for mapping consideration or exclusion. For example, the ICD-9-CM code 490, Bronchitis, not specified as acute or chronic, is mapped to J40 in ICD-10-CM. LEAP I-10 lists Z77.22, P96.81, Z87.891 as additional ICD-10-CM mapping options because they involve a related condition, exposure to tobacco smoke.
LEAP I-10 Analytics lets users simulate ICD-9-CM claims in ICD-10-CM and provides frequency data about the codes found in each. While the Reimbursement Maps provided by CMS are based on data in the MEDPAR analysis, your actual claims population may be significantly different than this data set. LEAP I-10 Analytics automatically recommends alternative maps, based on your claims history, that aligns with your patient population.
Request more information about the HLI GEMs+ Conversion Solution.