Angela R Campbell, RHIA

AHIMA Approved ICD-10-CM/PCS Trainer

Eastern Illinois University

*Differences are in the organization of ICD-10-CM

*ICD-10-CM has the same hierarchical structure as ICD-9-CM.

*First three characters of the code and all codes within the same category have similar traits.

*ICD-10-CM offers the addition of information relative to ambulatory and managed care encounters.

*Conditions that are new or that were not uniquely identified in ICD-9-CM have been assigned code numbers in ICD-10-CM.

*In ICD-10-CM, some three-character categories are not used in order to allow for revisions and future expansion.

*ICD-10-CM codes are alphanumeric and include all letters except "U”.

*ICD-9-CM’s V and E codes are incorporated into the main classification in ICD-10-CM.

*The length of codes in ICD-10-CM can be a maximum of seven characters.

*Injuries grouped by site of the injury, then type.

*New treatment protocol, new discoveries, new etiologies listed in a more appropriate chapter.

*Grouping of codes

*More complete descriptions

*Fifth and sixth characters

*Laterality

*Many categories

*Excludes notes

*Use of extensions

*Combination codes

*Terminology used

*Postprocedural conditions

*Trimester specificity

*New codes

Coding Examples Laterality

Coding Examples Combination Codes

K50.812Crohn’s disease of both small and large intestine with intestinal obstruction

K71.51Toxic liver disease with chronic active hepatitis with ascites

M05.271Rheumatoid vasculitis with rheumatoid arthritis of right ankle and foot

C50.512Malignant neoplasm of lower-outer quadrant of left female breast

ICD-9-CM ICD-10-CMThree to five characters Three to seven characters

First character may be alpha (E or V) or numeric; second thru fifth characters are numeric

First character alpha, second and third are numeric, characters 4 – 7 can be alpha or numeric

Limited space for adding new codes Flexible for adding new codes

Lacks detail Very specific

Lacks laterality Has laterality

Addition of a sixth character in some chapters

Addition of code extensions (seventh character) for obstetrics, injuries and external causes of injuries

Addition of dummy place holder (x)

Includes full code titles for all codes (no reference back to common fourth and fifth digits)

X

Category

Etiology, manifestatio

n, site

Etiology, Severity

, site

Extension

S 5 2 . 1 3 1 a

Displaced fracture of neck of right radius, initial encounter for closed fracture

ICD-9-CM Format ICD-10-CM Format

ICD-10-CM Example

Categories Section Titles

710 – 719 Arthropathies and Related Disorders720 – 724 Dorsopathies725 – 729 Rheumatism, Excluding the Back

730 – 739Osteopathies, Chondropathies, and Acquired Musculoskeletal Deformities

Categories Blocks

M00 - M02 Infectious arthropathiesM05 - M14 Inflammatory polyarthropathiesM15 - M19 Osteoarthritis

M20 - 25 Other joint disorders

M26 - M27Dentofacial anomalies (including malocclusion) and other disorders of the jaw

M30 - M36 Systemic connective disordersM40 - M43 Deforming dorsopathiesM45 - M49 SpondylopathiesM50 - M54 Other dorsopathiesM60 - M63 Disorders of the musclesM67 - M67 Disorders of synovium and tendonM70 - M79 Other soft tissue disordersM80 - M85 Disorders of bone density and structureM86 - M89 Other osteopathiesM91 - M94 Chondropathies

M95Other disorders of the musculoskeletal system and connective tissue

M96

Intraoperative and postprocedural compilations and disorders of musculoskeletal system, not elsewhere classified

M99 Biomechanical lesions, not elsewhere classified

*Category 274, Gout in ICD-9-CM Chapter 3, Endocrine, Nutritional and Metabolic Diseases and Immunity Disorders*M10, Gout, ICD-10-CM Chapter 13.

*Code 268.2, Osteomalacia, unspecified in ICD-9-CM Chapter 3*M83, Adult osteomalacia in ICD-10-CM Chapter 13.

*Code 524.4 Malocclusion, unspecified in ICD-9-CM Chapter 9, Diseases of the Digestive System*M26.4, Malocclusion, unspecified in ICD-10-CM Chapter

13.

*Code 526 Diseases of the jaw in ICD-9-CM Chapter 9*Moved to Chapter 13

Inflammatory Polyarthropathies (M05 – M14)

This section includes subcategories for:*Rheumatoid lung disease with rheumatoid arthritis (M05.1)*Rheumatoid vasculitis with rheumatoid arthritis (M05.2)*Rheumatoid heart disease with rheumatoid arthritis (M05.3)*Rheumatoid myopathy with rheumatoid arthritis (M05.4)*Rheumatoid polyneuropathy with rheumatoid arthritis (M05.5)*Rheumatoid arthritis with involvement of other organs and systems (M05.6)*Rheumatoid arthritis with rheumatoid factor without organ or systems involvement (M05.7)*Other rheumatoid arthritis with rheumatoid factor (M05.8)*Rheumatoid arthritis with rheumatoid factor, unspecified (M05.9)

*A initial encounter for fracture

*B subsequent encounter for fracture with routine healing

*G subsequent encounter for fracture with delayed healing

*K subsequent encounter for fracture with nonunion

*P subsequent encounter for fracture with malunion

*S sequelae

*The following must also be coded in addition to the type of fracture:

*Place of occurrence code

*Activity code

*Displaced vs. non-displaced

*Type of fracture

*Site of fracture

*Laterality

Other changes to this chapter include:*Postoperative complications have been moved to procedure-specific body system chapters.*Pyogenic arthritis is now classified by organism, specific site, and laterality. *Rheumatoid arthritis has 191 code options by type, manifestation, and laterality.*Osteomyelitis is now classified by type, acuity, specific site, and laterality. *Osteoarthritis is now classified by type, specific site, and laterality. *Systemic Lupus Erythematosus (SLE) is now classified by etiology or manifestation. *Scoliosis is classified by type and anatomical region of spine. *Pain in the limb, which had only one code option in ICD-9-CM, now has 31 code options based on specific site and laterality.

*ICD-10-CM groups injuries

*first by specific site (e.g., head, arm, leg),

*then by type of injury (e.g., fracture, open wound).

*Greater level of specificity in code selection

*Coders need detailed progress notes

*Detailed notes equal less inquires

*Reduction in A/R and claims turnaround

Pressure Ulcers

ICD-9-CM ICD-10-CM707.00 – 709.09 – broad location L89.131 – Pressure ulcer of right lower back,

Stage IL89.132 – Pressure ulcer or right lower back, Stage IIL89.133 – Pressure ulcer or right lower back, Stage IIIL89.141 – Pressure ulcer of left lower back, Stage IL89.149 – Pressure ulcer of left lower back, unspecified stage

Asthma

ICD-9-CM ICD-10-CM

493.00 – 493.92 – code range

J45.20 – J45.998 note large expansion of codes

- extrinsic vs. intrinsic- chronic obstructive asthma- with status asthmaticus- with exacerbation- exercise induced bronchospasm- cough variant asthma

- mild intermittent- mild persistent- moderate persistent- severe persistent- with status asthmaticus- with exacerbation- exercise induced bronchospasm- cough variant asthma- excludes chronic obstructive asthma

*E codes now Y or V categories

*V codes were replaced by Z codes

*Represent reasons for encounters other than disease

*BMI located in this section Z68

*Pediatric and adult codes

*ICD-10-CM and ICD-10-PCS

*October 1, 2014

*Date of discharge for inpatient claims

*Date of service for outpatient claims

*HHS had stated the date will not be extended.

*Coding errors

*Backlog of claims

*Change in documentation requirements

*Superbills – expansion to accommodate increased codes, may require alternative

*Confusion and possible slow claims transactions with claims administrators

*Coding professionals*Physicians*Other healthcare professional*Nonphysician clinicians/ancillary department

personnel*Utilization management personnel* Software vendors* Information systems personnel*Billing/accounting personnel*Compliance officers* Fraud investigators*Government agency personnel

*Staff

*Professional Organizations

*World Health Organization

*Software Vendors

*EMR, Encoders/Coding solutions

*Industry specific organizations

*Journals/Magazines

*Universities/Community Colleges

*Consultants

*World Health Organization (WHO)*http://www.who.int/classifications/icd/en/

*Centers for Medicare and Medicaid Services (CMS) (2 free modules, CME credit)*http://www.cms.gov/Medicare/Coding/ICD10/

index.html?redirect=/icd10

*Centers for Disease Control and Prevention (CDC)*http://www.cdc.gov/nchs/icd/icd10.htm

*U.S. Department of Health and Human Services*http://www.hrsa.gov/healthit/toolbox/

webinars/pdfs/icd10.pdf

*American Health Information Management Association (AHIMA)

*http://www.ahima.org/icd10/

*AAPC

*http://www.aapc.com/icd-10/

*For the Record Magazine

*http://www.fortherecordmag.com

*Health Data Management

*http://www.healthdatamanagement.com/

*Healthcare IT News

*http://www.healthcareitnews.com/

*HIMSS

*http://www.himss.org/library/icd-10/playbook

*ICD10Monitor

*http://ICD10Monitor.com

*ICD-10 Education (Free webinars, readiness assessments)

*http://www.icd10-education.com/

*ICD 10 Watch

*http://www.icd10watch.com/

*Step 1 – Impact Analysis: 3 – 6 months

*Step 2 – Contact your Vendors: 2 – 3 months

*Step 3 – Contact your Payers, Billing Service and Clearinghouse: 2 – 3 months

*Step 4 – Installation of Vendor Upgrades: 3 – 6 months

*Step 5 – Internal Testing: 2 – 3 months

*Step 6 – Update Internal Processes: 2 – 3 months

*Step 7 – Conduct Staff Training: 2 – 3 months

*Step 8 – External Testing with Clearinghouses, Billing Service, and Payers: 6 – 9 months

*Step 9 – Make the Switch to ICD-10: October 1, 2014

*After October 1, 2014

*General Equivalence Mappings*Developed for specific, limited short-term

need

*Reference mappings

*Not a substitute for using/learning ICD-9-CM and ICD-10-CM/PCS

*Links concepts without consideration of context or encounter information

*Two GEM files available allowing for bidirectional

mappings.* ICD-9-CM to ICD-10-CM

* ICD-10-CM to ICD-9-CM

*Basic conventions are the same

*All letters used in alphabet with exception of U

*Be careful in writing a zero vs. and “o”, or an “I” vs. one.

*Read, read, read, notes at the beginning of each chapter – the only way to become familiar with guideline changes

*ICD-10-CM will allow comparison of mortality and morbidity data

*Incorporates much greater specificity and clinical information