ICD-10 - Blue Cross Blue Shield of RI · 2020-03-04 · In general, ICD‐10 codes are more specific than ICD‐9. Certain cases exist where ICD‐9 is more specific than ICD‐10:

ICD-10Sarah Enright

Provider Relations

What is ICD?• The ICD is the international standard diagnostic

classification for many health management purposes and clinical use including:– Analysis of the general health situation of population

groups– Monitoring of the incidence and prevalence of diseases

and other health problems in relation to other variables • Used to classify diseases and other health problems

recorded on many types of health and vital records.• Enables the storage and retrieval of diagnostic information

for clinical, epidemiological, and quality purposes.• Provides the basis for the compilation of national mortality

and morbidity statistics.

Who Maintains ICD-10?

• ICD-10-CM– National Center for Health Statistics (NCHS)– Centers for Disease Control and Prevention

(CDC)• ICD-10-PCS

– Centers for Medicare and Medicaid Services (CMS)

Federal Mandate

In January 2009, the Department of Health and Human Services issued a final rule requiring all HIPAA-covered entities to use ICD-10 diagnosis and procedure codes for HIPAA transactions with dates of service or dates of discharge on or after October 1, 2013.

HIPAA 5010 Compliance

Nomenclature Change

Why Transition to ICD-10?

• ICD-9 produces limited data about patients’ medical conditions and inpatient hospital procedures.

• ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice.

• The structure of ICD-9 limits the number of new codes that can be created; many ICD-9 categories are full.

Comparison ICD‐9‐CM ICD‐10‐CM

# of Characters 3‐5 Numeric

(+V and E codes)

3‐7 Alphanumeric

# of Codes ~ 13,500 ~ 68,000

Comparison ICD‐9‐CM ICD‐10‐PCS

# of Characters 3‐4 Numeric 7 Alphanumeric

# of Codes ~ 4,000 ~ 72,000

Diagnosis Codes

Procedure Codes

Structural Differences Between ICD-9 and ICD-10

Information Patterns

In general, ICD‐10 codes are more specific than ICD‐9.Certain cases exist where ICD‐9 is more specific than ICD‐10:

Method of detection eliminated in ICD‐10.Legal status and completeness of procedure eliminated in ICD‐10.

896.2 Traumatic amputation of foot

S98.011A Complete traumatic amputation of (complete or partial) bilateral

right foot at ankle level, initial encounterwithout mention of complication

S98.012A Complete traumatic amputation of left foot at ankle level, initial encounter

S98.021A Partial traumatic amputation of right foot at ankle level, initial encounter

S98.022A Partial traumatic amputation of left footat ankle level, initial encounter

ICD‐9 Code and Description

ICD‐10 Codes and Description

Differences in Specificity

Diagnosis Codes for Sprained and Strained Ankles: ICD-9-CM vs. ICD-10-CM

4 ICD‐9 Codes

845.00

Sprain and strain

of ankle, unspecified

site

845.01

Sprain and strain

of ankle, Deltoid

ligament/Internal

collateral ligament

845.02 Sprain and strain

of ankle,

Calcaneofibular

(ligament)

845.03 Sprain and strain

of ankle, Tibiofibular

(ligament) distal

72 ICD‐10 CodesS93.401A Sprain of unspecified

ligament of right ankle ‐

initial

encounterS93.401D

Sprain of unspecified

ligament of right ankle –

subsequent

encounterS93.401S


ligament of right ankle – sequelaS93.402A


ligament of left ankle ‐

initial

encounterS93.402D


ligament of left ankle –

subsequent

encounterS93.402S



sequelaS93.409A


ligament of unspecified ankle ‐

initial

encounterS93.409D


ligament of unspecified ankle–

subsequent encounterS93.409S



sequelaS93.421a

Sprain of deltoid ligament

of right ankle ‐

initial encounterS93.421d


of right ankle – subsequent

encounterS93.421q


of right ankle –SequelaS93.422a


of left ankle ‐

initial encounterS93.422d


of left ankle –

subsequent encounterS93.422q


of left ankle –

sequelaS93.429a


of ankle unspecified ‐

initial

encounterS93.429d


of unspecified ankle–

subsequent

encounterS93.429q


of unspecified ankle–

sequelaS93.411A

Sprain of calcaneofibular


initial

encounterS93.411D



subsequent

encounter

S93.411S





initial

encounterS93.412D



subsequent

encounterS93.412S



sequelaS93.419A



initial

encounterS93.419D





ligament of unspecified ankleS93.431A

Sprain of tibiofibular


initial

encounterS93.431D



subsequent

encounterS93.431S





initial

encounterS93.432D



subsequent

encounterS93.432S



sequelaS93.439A



initial

encounterS93.439D






sequelaS93.491A

Sprain of other ligament of

right ankle (Internal

collateral/talofibular) initial encounterS93.491D



collateral/talofibular) subsequent

encounterS93.491S



collateral/talofibular) sequela

S93.492A


left ankle, initial encounterS93.492D


left ankle subsequent encounterS93.492S


left ankle sequelaS93.499A


unspecified ankle initial encounterS93.499D


unspecified ankle subs encounterS93.499S


unspecified ankle (Internal

collateral/talofibular) sequelaS96.211A

Strain of intrinsic muscle and

tendon at right ankle and foot level

initial encounterS96.211D






sequelaS96.212A


tendon at left ankle and foot level

initial encounterS96.212DStrain of intrinsic muscle and





sequelaS96.219A


tendon at ankle and foot level,

unspecified side initial encounterS96.219D



unspecified side subs encounterS96.219S



unspecified sideS96.811A

Strain of other muscles and

tendons at right ankle and foot level

initial encounter S96.811D



subsequent encounter

S96.811S



sequelaS96.812A


tendons at left ankle and foot level







sequelaS96.819A


tendons at ankle and foot level,

unspecified side initial encounterS96.819D



unspecified side subs encounterS96.819S



unspecified side sequelaS96.911A

Strain of unspecified muscle

and tendon at right ankle and foot

level initial encounterS96.911D



level subs encounterS96.911S



level sequelaS96.912A


and tendon at left ankle and foot level




subs encounterS96.912S



sequelaS96.919A


and tendon at ankle and foot level,

unspec. side initial encounterS96.919D



unspec. side subs encounterS96.919S



unspec. side sequela


ICD‐9 has been evolving over the past 25‐30 years:Changes not consistent throughoutDiffering levels of specificity across chapters

ICD‐10 attempts to standardize levels of specificity and make them consistent across chapters.ICD‐10 classifies conditions by the stage of treatment vs. the episode of care.

ICD‐9 has been evolving over the past 25‐30 years:Changes not consistent throughoutDiffering levels of specificity across chapters

ICD‐10 attempts to standardize levels of specificity and make them consistent across chapters.ICD‐10 classifies conditions by the stage of treatment vs. the episode of care.

ICD‐10 Codes and Descriptions ICD‐9 Codes and Descriptions

026.851

649.51

Spotting complicating pregnancy, first trimester

Spotting complicating pregnancy,

delivered

026.852

649.53

Spotting complicating pregnancy, second trimester

Spotting complicating pregnancy,

026.853

antepartum

Spotting complicating pregnancy, third trimester

026.859

Spotting complicating pregnancy, unspecified trimester


More extensive vocabulary of clinical concepts, body part specificity, patient encounter information, and other components from which codes are built.

ICD‐9 Code and Description

ICD‐10 Codes and Descriptions

87353

S01521A Laceration with foreign body of lip, initial encounter

Complicated open wound

S01511A Laceration without foreign body of lip, initial encounter

of lip

S01521D Laceration with foreign body of lip, subsequent

encounter

S01511D Laceration without foreign body of lip,

subsequent encounter

S01541A Puncture wound with foreign body of lip, initial

encounter

S01531A Puncture wound without foreign body of lip, initial

encounter

S01541D Puncture wound with foreign body of lip, subsequentencounter

Differences in Classification

Recommended Discovery Tasks for ProvidersJanuary to March 2011• Identify competing projects and determine the priority of

ICD-10.• Identify current systems that use ICD-9 codes.• Identify current reports that contain ICD-9 codes.• Identify current business processes that use ICD-9 codes.• Review vendor contract language to determine if ICD-10

system upgrades are required and included in contract.• Analyze business processes to identify changes required.

Recommended Discovery Tasks for ProvidersApril to June 2011• Contact system vendors to determine if and when an

ICD-10 complete upgrade will be offered.• Analyze revenue and productivity impacts.• Assess staff training needs.• Estimate costs and budgetary implications.• Contact clearinghouses, billing services, and payers to

determine when they will be ready to test.

ICD-10 on Provider Home Page of BCBSRI.com

ICD-10 Landing Page on BCBSRI.com

ICD-10 Noncompliance

• Your claims and other transactions may be rejected.

• You will need to resubmit them with the ICD-10 codes.

• This may result in delays in reimbursement.

Thank you!

Documents

ICD-10 - Blue Cross Blue Shield of RI · 2020-03-04 · In general, ICD‐10 codes are more specific than ICD‐9. Certain cases exist where ICD‐9 is more specific than ICD‐10: