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September, 2013

ICD-10 BASICS

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What is ICD-10? ICD-10 stands for International Classification of Diseases,10thRevision

This coding system is published by the World HealthOrganization (WHO)

The coding system is used as a tool to describe the clinicalpicture of the patient and for billing purposes.

All industrialized countries in the world are already usingICD-10, such as Canada, Brazil, UK, France, Ireland, China

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ICD-10 CM vs PCS?

ICD-10-CM: International Classification of Diseases, 10thRevision, Clinical Modifications this is the diagnotic portionof the coding system published by the United StatesGovernment (customized for the USA).

ICD-10-PCS: International Classification of Disease, 10thRevison, Procedure Classification System, has beendeveloped to capture procedures, this was funded by the

U.S. Centers for Medicare and Medicaid Services.

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ICD-10 Implementation October 1, 2014, is the compliance date for implementation

of ICD-10-CM (diagnoses) and ICD-10-PCS (procedures)

No more delays

ICD-10-CM (diagnoses) will be used by all providers in everyhealth care setting

ICD-10-PCS (procedures) will be used only for hospital claims

for inpatient hospital procedures

ICD-10-PCS will not be used on physician claims, even those

for inpatient visits

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When to use ICD-10

If the date of service is before 10/1/2014,

ICD-9 will be used

Dates of service On or After 10/1/2014,

use ICD-10

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Basic Coding Differences

ICD-9

ICD-9 CM has 14,025

3-5-character alphanumeric

diagnosis codes with 855code categories.

ICD-9 PCS has 3,824 3-4-

character numericprocedure codes

ICD-10

ICD-10 CM has 68,000+ 3-

7-character alphanumeric

diagnosis codes with 2,000+code categories.

ICD-10 PCS has 72,000+ 7-

character alphanumericprocedure codes.

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ICD-10 CM Format

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Differences

Going from 14,000 codes to over 68,000 CM

(diagnostic) codes:

Requires greater specificity

Laterality (right or left designation)

Stages of healing

Trimesters in pregnancy

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ICD-10 PCS (procedure) Code Structure

Character 1

Device

Character 2 Character 3 Character 7Character 5Character 4

ApproachRootOperation

Character 6

Section Body System Body Part Qualifier

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Medical Surgical PCS

Valid code containsseven characters

Each character has a

specific meaning

Character meaningschange by Sections

Character values may

change by root

operation

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Character 1

Device

Character 2 Character 3 Character 7Character 5Character 4

ApproachRoot

Operation

Character 6

SectionBody

SystemBody Part Qualifier

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Sections of ICD-10-PCS

Character1

Section

First CharacterSections identify the general type of

procedure

Sections of ICD-10-PCS

0Medical / Surgical

1Obstetric

2Placement

3Administration

4Measurement & Monitoring

5Extracorporeal Assistance & Performance

6Extracorporeal Therapies

7Osteopathic

8Other Procedures

9Chiropractic

BImaging

CNuclear Medicine

DRadiation Oncology

FPhysical Rehabilitation & Diagnostic Audiology

GMental Health

HSubstance Abuse Treatment

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Second Character

Body system, general physiological system oranatomical region involved

29 body systems

3 general anatomical regions

Categorization into larger grouping

Tables easier to navigate

Provides information quickly about procedure

All procedures with same second character are thesame anatomical region or body system

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Character 2

Body

System

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Body System versus Body Part

Body System

Body Part

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Body System Guidelines

General anatomical regions body systems

Anatomical region rather than a specific body

part

No information is available to code to a specific

body part

Upperor Lower qualifier

Location above or below the diaphragm

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What is the Value of ICD-10?

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Greater coding accuracy and specificity

Higher quality information for measuring

healthcare service,

quality, safety and

security

Improved efficiencies and lower costs

Reduced coding errors

Alignment of the US with coding systems

worldwide

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Helpful ICD-10 Web Sites General ICD-10 Information: http://www.cms.gov/ICD10

ICD-10-PCS Coding System, Mappings, and Related Training Manual

http://www.cms.gov/ICD10/13_2010_ICD10PCS.asp

Transactions and Code Sets Regulations

http://www.cms.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsReg

ulations.asp

American Health Information Management Association: http://www.ahima.org

Workgroup For Electronic Data Interchange (WEDI)

http://www.wedi.org

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http://www.cms.gov/ICD10http://www.cms.gov/ICD10/13_2010_ICD10PCS.asphttp://www.cms.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asphttp://www.cms.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asphttp://www.ahima.org/http://www.wedi.org/http://www.wedi.org/http://www.wedi.org/http://www.ahima.org/http://www.ahima.org/http://www.ahima.org/http://www.cms.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asphttp://www.cms.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asphttp://www.cms.gov/ICD10/13_2010_ICD10PCS.asphttp://www.cms.gov/ICD10