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ICD-10 for IRF on the Horizon

Written by: Darlene D'Altorio-Jones (1959-2015) on Thursday, March 20, 2014 Posted in: Inpatient Rehab

Get ready.  Although the present IRF PAI has but 10 spaces to record co-morbid conditions.  We had seen in the released rule for 2014 that the new eight page IRF PAI, page one, proposes to more closely match the uniform bill and will enable coding nearly the entire alphabet A-Y or 25 spaces.  To add to the mystery it says ‘use an ICD code’ but did not reveal whether that code will remain ICD-9 as it discloses in the previous printed PAI instructions.


With certainty, in hearing Laurence Wilson, Director of Chronic Care Policy Group, CMS, speak at the AMRPA conference; he mentioned that implementing ICD-10 roll-out for all levels of care October 1st, 2014 is the scheduled plan.  This includes IRF.

Mr. Wilson reiterated in rule making published last year there would be removal of codes toward presumptive inclusion as well as republished documents that we presently utilize in coding the IRF PAI for tiering and presumptive listing.

How might this be done?  The use of General Equivalency Mapping (GEM), was mentioned as a possibility.

The Medicare Learning Network has published an educational guide on GEM.  PRINT or SAVE IT.

This education document describes GEMs in this way:

“What are the GEMs?
The GEMs are a tool you can use to convert data from ICD-9-CM to ICD-10-CM and ICD-10-PCS and vice versa. The GEMs are also known as crosswalks as they provide important information linking codes of one system with codes in the other system. The GEMs are a comprehensive translation dictionary that can be used to accurately and effectively translate any ICD-9-CM-based data, including data for:
u0099 u0099
u0099Tracking quality;
Recording morbidity/mortality;
Calculating reimbursement; or
Converting any ICD-9-CM-based application to ICD-10-CM/PCS such as:
u2022Payment systems;
u2022Payment and coverage edits;
u2022Risk adjustment logic;
u2022Quality measures; and
u2022A variety of research applications involving trend data. ”

So, with some certainty I would recommend that as you prepare for ICD-10 capabilities as Mediware Rehabilitation products has,  that you learn more about GEM.  It appears this is the new precious ‘stone’ we will be reflecting upon as we push toward the deadline October 1st, 2014.

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