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G1: Approximate [FLAG]
Attribute in a GEM that when turned on indicates that the entry is not considered equivalent
1 = Yes/On
0 = No/Off
G2: No Map [FLAG]
Attribute in a GEM that when turned on indicates that a code in the source system is not linked to any code in the target system.
1 = Yes/On
0 = No/Off
G3: Combination Entry [FLAG]
Attribute in a GEM that when turned on indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system
1 = Yes/On
0 = No/Off
An entry in a GEM for which a code in the source system must be linked to more than one code option in the target system to be a valid entry.
An entry of the combination type is characterized by a compound correspondence: code A in the source system must be linked as a unit to code A and code B and code C in the target system to be a valid correspondence. Attributes in a GEM file clearly signal these special cases.
Stated another way, it takes more than one code in the target system to satisfy all of the meaning contained in one code in the source system. As discussed in this section, the situation occurs both when I-9 is the source system and when I-10 is the source system.
G4: Scenario
In a combination entry, a collection of codes from the target system containing the necessary codes that when combined as directed will satisfy the equivalent meaning of a code in the source system
0 - 9
G5: Choice List
In a combination entry, a list of one or more codes in the target system from which one code must be chosen to satisfy the equivalent meaning of a code in the source system
0 - 9
The word 'Includes' appears immediately under certain categories to further define, or give examples of, the content of thecategory.
Excludes Notes:
The ICD-10-CM has two types of excludes notes. Each note has a different definition for use but they are both similar in thatthey indicate that codes excluded from each other are independent of each other.
A type 1 Excludes note is a pure excludes. It means 'NOT CODED HERE!' An Excludes1 note indicates that the codeexcluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when twoconditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
A type 2 excludes note represents 'Not included here'. An excludes2 note indicates that the condition excluded is not part ofthe condition it is excluded from but a patient may have both conditions at the same time. When an Excludes2 note appearsunder a code it is acceptable to use both the code and the excluded code together.
Code First/Use Additional Code notes (etiology/manifestation paired codes)
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.For such conditions the ICD-10-CM has a coding convention that requires the underlying condition be sequenced firstfollowed by the manifestation. Wherever such a combination exists there is a 'use additional code' note at the etiology code,and a 'code first' note at the manifestation code. These instructional notes indicate the proper sequencing order of thecodes, etiology followed by manifestation.
In most cases the manifestation codes will have in the code title, 'in diseases classified elsewhere.' Codes with this title area component of the etiology/ manifestation convention. The code title indicates that it is a manifestation code. 'In diseasesclassified elsewhere' codes are never permitted to be used as first listed or principal diagnosis codes. They must be used inconjunction with an underlying condition code and they must be listed following the underlying condition.
Code Also:
A code also note instructs that 2 codes may be required to fully describe a condition but the sequencing of the two codes isdiscretionary, depending on the severity of the conditions and the reason for the encounter.
7th characters and placeholder X
For codes less than 6 characters that require a 7th character a placeholder X should be assigned for all characters lessthan 6. The 7th character must always be the 7th character of a code
Because there are GEM codes that result in a “NoDx”. To resolve this I have stayed true to the GEM process intent. Most of the codes that would result in “NoDx” do have a higher heirarchical level code description.
E.G., ICD 10-9 GEM codes from HHS/CDC/CMS, S46929A/88020, will result in a “NoDx” for the ICD-9 code.

ICD-10 ==> S46.929A: Laceration of unspecified muscle, fascia and tendon at shoulder and upper arm level, unspecified arm
ICD-9 ==> 880: Open wound of shoulder and upper arm The following fifth-digit subclassification is for use with category 880: 0=shoulder region 1=scapular region 2=axillary region 3=upper arm 9=multiple sites
ICD-9 ==> 880.2: With tendon involvement [0-3,9]
ICD-9 ==> 880.20: NoDx

Since some of the GEM codes from HHS/CDC/CMS are sent with 5 character ICD-9 codes that have no description. So I am retrieving the next higher heirarchical level that does not have a “NoDx”. This will allow a valid albeit a higher heirarchical level description, I inclde the higher heirarchical level ICD-9 code concatenated to that higher heirarchical level ICD-9 description to indicate that.

With the 880.2 code, the [0-3,9] represents the 5th character of the ICD-9 code(s) of 88020,88022,88023,88029 respectively.

So, this means 880.20 could be manually organized as:
880.20: Open wound of shoulder and upper arm with tendon involvement shoulder region.

880.20: Open wound of shoulder and upper arm with tendon involvement.

Or, as HHS/CDM/CDC code is supplied
880.20: NoDx

Or, as the ICD-GEM Manager generates indicating a NoDX condition at the heirarchical level, and returning the code and description from the higher hierarchical level with a valid description.
88020: 880.2: With tendon involvement [0-3,9]

NOTE: If you do not want the higher heirarchical level to describe, the feel free to use the HHS/CDC/CMS “NoDx” designation.
Chick Here for ==> Copyright Notice

NOTICE: Mr.Dwyer/RedRavenProductions©™ is the proprietor of all copyright in a literary-artistic-musical work entitled "ICD-GEM" & "ICD 9-10 GEM" (International Statistical Classification of Diseases and Related Health Problems, 9th revision code set to the 10th revision code set General Equivalence Mapping) Manager-SuperBill-Loader (The "Work"). Mr.Dwyer/RedRavenProductions©™ has reserved all rights in the Work. Initial concept, design and development of the "ICD-GEM Manager©™" began in 1997 and was expressed in material form on March 2 2000. Mr.Dwyer/RedRaven Productions©™ reserves all rights under 17 U.S.C. Section 101 et seq. and any infringement on these rights could be liable for statutory damages as high as $150,000 as set forth in Section 504(c)(2) therein.