GEM (General Equivalent Mappings) Cont.

1. The Approximate Flag (1st flag)

The approximate flag identifies entries where the complete meaning of the source system code and that of the target system code are not considered equivalent.

The approximate flag is 0 when the complete meaning of the source and the target are considered equivalent and the source and target translate only to each other in both GEMs files.

The screen shot used an example of an identical match. ICD-9 code 788.33 – Mixed incontinence directly translates to ICD-10 N36.46

When the approximate flag is 1 the complete meaning of the source and the target are not considered equivalent.

2. The No Map Flag (2nd flag)

The no map flag is 0 when there is a translation in the target system for the source system code. The no map flag is 1 when there is no acceptable translation in the target system for the source system code

The Combination Flag (3rd flag)

The combination flag is 0 when the translation alternative in the target system is what is referred to as a single entry rather than a combination entry. A single entry in the context of the GEMs has a specific meaning. It means that the code in the source system linked to one of the translation options in the target system is a considered a complete translation alternative.

The combination flag is 1 when the translation alternative in the target system is a combination entry. When the combination flag is 1 for a source system code, it means that a cluster of target system codes—consisting of two, three, four, or more codes— taken together provide an adequate translation of the source system code.

Scenario 4th Flag

A source system combination code includes diagnostic conditions or procedures that require more than one separate code in the target system to convey the equivalent amount of information. A combination code may also describe multiple variations of the information in either the code title or the complete meaning of the code. Each of these variations has its own number in the scenario field (the 4th flag). If there is only one scenario in a GEMs combination entry, the scenario number is 1 for all rows in the entry. If there is more than one scenario in a GEMs combination entry, each additional variation of a combination diagnosis or procedure has its own scenario number, beginning with 1, 2, 3, and so on.

Choice 5th Flag

Choice lists are the method of organization for the translation alternatives in a combination entry. Choice lists organize the distinct components of the target system translation in a combination entry into pick lists. If the source system code requires three distinct target system codes to convey the equivalent amount of information, the target system translation will contain three pick lists. If the target system is more specific along one or more axes of classification, there will be multiple translation alternatives for that axis of classification and the pick list will contain multiple choices. One target system code from each of the choice lists in an entry constitute a complete translation of the source system combination code. Each instance of a complete translation is called a cluster.