What the CMS doesn't tell you about translating ICD-9 codes to ICD-10

The Centers for Medicare and Medicaid publish a free kit for translating ICD-9 codes to ICD-10 (and vice versa). It's called GEMS (for General Equivalence Mappings).

But what the CMS doesn't tell you is that GEMS takes a relatively non-specific code set (ICD-9) and translates it into an equally non-specific set of ICD-10 codes. That defeats the whole purpose of ICD-10!

Let me give you an example of what I'm talking about. Consider ICD-9 code 896.2. It's formal description is:

Traumatic amputation of foot (complete) (partial): bilateral, without mention of complication

GEMS would have you translate this as a pair of codes, restaurant menu style:

For your entree, pick one of these:

  • S98.911A Complete traumatic amputation of right foot, level unspecified, initial encounter
  • S98.921A Partial traumatic amputation of right foot, level unspecified, initial encounter

And for your main course, pick one of these:

  • S98.912A Complete traumatic amputation of left foot, level unspecified, initial encounter
  • S98.922A Partial traumatic amputation of left foot, level unspecified, initial encounter

Did you notice that all the descriptions have the word "unspecified" in them?

If you do a little (OK, a lot) of digging, you can come up with a much more satisfying menu. Please click here to see our take on what the above translation really should look like.

 


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