ICD-10-CM is the new diagnosis coding system that was developed as a replacement for ICD-9-CM, Volumes 1 & 2.
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ICD-10-CM and GEMs (2021)
ICD-10-CM is the United States' clinical modification of the World Health Organization's ICD-10. The term "clinical" is used to emphasize the modification's intent: to serve as a useful tool in the area of classification of morbidity data for indexing of health records, medical care review, and ambulatory and other health care programs, as well as for basic health statistics. To describe the clinical picture of the patient the codes must be more precise than those needed only for statistical groupings and trend analysis.
Characteristics of ICD-10-CM
ICD-10-CM far exceeds its predecessors in the number of concepts and codes provided. The disease classification has been expanded to include health-related conditions and to provide greater specificity at the sixth and seventh character level. The sixth and seventh characters are not optional and are intended for use in recording the information documented in the clinical record.
ICD-10-CM extensions, interpretations, modifications, addenda, or errata other than those approved by the Centers for Disease Control and Prevention are not to be considered official and should not be utilized. Continuous maintenance of the ICD-10-CM is the responsibility of the aforementioned agencies. However, because the ICD-10-CM represents the best in contemporary thinking of clinicians, nosologists, epidemiologists, and statisticians from both public and private sectors, when future modifications are considered, advice will be sought from all stakeholders.
All official authorized addenda since the last complete update (October 1, 2019) have been included in this revision. For more detailed information please see the complete official authorized addenda to ICD-10-CM, including the "ICD-10-CM Official Guidelines for Coding and Reporting," and a description of the ICD-10-CM updating and maintenance process.
The 2021 ICD-10-CM files in this edition contain information on the ICD-10-CM updates for FY 2021. These 2021 ICD-10-CM codes are to be used for discharges occurring from October 1, 2020, through September 30, 2021, and for patient encounters occurring from October 1, 2020, through September 30, 2021.
Note: The Reimbursement Mappings are no longer being updated and posted. There is no FY 2021 GEMs file. As stated in the FY 2016 IPPS/LTCH PPS final rule (80 FR 49388), the GEMs have been updated on an annual basis as part of the ICD-10 Coordination and Maintenance Committee meetings process and will continue to be updated for approximately 3 years after ICD-10 is implemented. An announcement was also made at the September 2017 ICD-10 Coordination and Maintenance Committee meeting that FY 2018 would be the last GEMs file update.
ICD-10 MS-DRG Conversion Project
This section provides information on the project for using the General Equivalence Mappings (GEMs) to convert the draft MS-DRGs to ICD-10-CM and ICD-10-PCS. Information is also provided on undertaking a similar conversion project.