Is Use of GEMs to Prepare for ICD-10 Wise?

In preparation for ICD-10, the federal government developed GEMs, a translation tool to aid in converting data from ICD-9 to 10, and vice versa. But leaders of outsourced coding, auditing and consulting services firm HRS say the tool has limitations and its use should be carefully considered.

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Comments (1)
GEMs are currently viewed as being mostly useful during the transition of billing systems to I10. As the article above makes clear, this kind of use is highly fraught for multiple reasons.

The GEMs themselves are much more forward-compatible than backward-compatible; not all I10s can find a happy home anywhere in I9. Forward-converted I9s will frequently end up in "rubbish can" I10 defaults, where an I10-enabled billing system would permit greater specificity and hence more accurate billing. But these issues will come to an end when clinical and billing systems have all moved to I10.

My comment, from a data analyst's standpoint, is that one issue will persist -- and for many years to come. GEMs will also play an essential role in any retrospective data analyses that span the given database's I9 / I10 cutover date. Thus, there's a likelihood that vendors will embed GEMs in their analytical products. This will tend to mask the intrinsic issues with GEMs by putting them "under the hood".

Health data analysts will have to be keenly aware of hidden "gotchas" each and every time a data analysis is undertaken. Even more problematic will be things like dashboards designed for CEOs or CFOs, where data are automatically generated and pasted on the screen. One can't expect them to grasp the intricacies of these code conversions. That puts all the burden back on developers, and it's a heavy lift.
Posted by Mark L | Thursday, July 24 2014 at 1:02PM ET
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