Table 1.
Categories of Recommended Additions or Deletions to GEM‐Mapped Codes, with Example Comments
| Level | Description | Examples of Reasons for Designation at This Level |
|---|---|---|
| 1 | For “legacy” specifications: Codes involving concepts that were never intended to be part of the QI specifications; addressing these recommendations would theoretically align the ICD‐10‐CM/PCS version of the QIs as closely as possible to the ICD‐9‐CM version | The mapped code is specific to the incorrect gender |
| The mapped code is specific to an incorrect age group (e.g., adult condition for a pediatric concept) | ||
| The mapped code is an unnecessary component of a cluster that is better captured by other code(s) | ||
| The mapped code is included in a different code set (redundant) | ||
| The mapped code involves a newly classified clinical concept that does not fit with the intent of this set | ||
| The mapped code is specific to an incorrect anatomic site | ||
| The mapped code pertains to a specific (and incorrect) time duration whereas the original code is expressly non‐specific | ||
| 2 | For “enhanced” specifications: Codes involving clinical concepts that can be specified more precisely in the ICD‐10‐CM/PCS version of the indicator specifications, either because of limitations of ICD‐9‐CM or enhanced capabilities of ICD‐10‐CM/PCS; addressing these recommendations would theoretically optimize the indicators for use with ICD‐10‐CM/PCS (as version 6.0 of the QIs) | The mapped code is not as specific to the intent of the code set as other code(s) |
| The unmapped code represents a clinical concept that fits with the intent of this set | ||
| 3 | For “deferred” consideration: Codes involving more complex mapping problems or entailing a fundamental re‐examination of prior choices regarding the design of the indicator; addressing these recommendations would be outside the scope of the conversion process, though potentially warranted at a future time | The unmapped code represents a clinical concept that might fit with the intent of this set |
| The mapped code arguably does not fit with the intent of this set |