ICD-10-CM ChangesPat Shaw

ICD-10-CM replaces ICD-9-CM for diagnosis in all settings

ICD-10-PCS replaces ICD-9-CM volume 3 procedures codes for hospital inpatient procedures only

CPT/HCPCS is not affected Implementation discharges/encounters on or

after October 1, 2014.

ICD-10

X X X X

Category

.Etiology, anatomic

site, severity

Added code extensions (7th character) for obstetrics, injuries, and external causes of injury

3

Coding and 7th Character Extensions

X X XAMS 0 2 6. 5 x A

Additional Characters

Alpha (Except

U)

2 Numeric3 - 7 Numeric or

Alpha

3 – 7 Characters

Coding in ICD-10-CM

4

ICD-9-CM ICD-10-CM

Three to five characters Three to seven characters

First digit is numeric but can be alpha (E or V)

First character always alpha

2-5 are numeric All letters used except U

Always at least three digits Character 2 always numeric: 3-7 can be alpha or numeric

Decimal placed after the first three characters (or with E codes, placed after the first four characters)

Always at least three digits

Alpha characters are not case-sensitive

Decimal placed after the first three characters

Alpha characters are not case-sensitive

Diagnoses ICD-9-CM - 14,025 ICD-10-CM - 68,069

Procedures ICD-9-CM - 3,824 ICD-10-PCS - 72,589

ICD-10-CM Overview

Benefits of ICD-10-CM ICD-10-CM incorporates much greater clinical detail and

specificity than ICD-9-CM Terminology and disease classification have been updated to

be consistent with current clinical practice A new modern classification system will provide much better

data needed for: Measuring care, quality, safety, and efficacy of care

Reduction of paper work related to documentation queries

Improving payment systems and reimbursement

ICD-10-CM Overview

New ICD-10-CM features Laterality (left, right, bilateral)

Examples: C50.511 - Malignant neoplasm of lower-outer quadrant of

right female breast H16.013 - Central corneal ulcer, bilateral L89.012 - Pressure ulcer of right

elbow, stage II

ICD-10-CM Overview

Combination codes for certain conditions and common associated symptoms and manifestations Examples:

K57.21 - Diverticulitis of large intestine with perforation and abscess with bleeding

E11.341 - Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema

I25.110 - Atherosclerotic heart

ICD-10-CM Overview

Combination codes for poisonings and associated external cause Example:

T42.3X2S - Poisoning by barbiturates, intentional self-harm, sequela

Obstetric codes identify trimester instead of episode of care Example:

O26.02 - Excessive weight gain in pregnancy, second trimester

ICD-10-CM Overview

Character “X” Used as a 5th character placeholder in to allow for future

expansion and to fill in other empty characters Used when a code less than 6 characters in length

requires a 7th character Examples:

T46.1X5A - Adverse effect of calcium-channel blockers, initial encounter

T15.02XD - Foreign body in cornea, left eye, subsequent encounter

ICD-10-CM Overview

ICD-10-CM Overview

Two types of Excludes notes Excludes 1

Indicates the code excluded should never be used with the code where the note is located Do not report both codes

Example: Q03 - Congenital hydrocephalus Excludes 1: Acquired hydrocephalus - G91

ICD-10-CM Overview

Excludes 2 Indicates the condition excluded is not part of the condition

represented by the code A patient may have both conditions at the same time Both codes may be assigned together to capture both

conditions Example:

L27.2 - Dermatitis due to ingested food Excludes 2: Dermatitis due to food in contact with skin - L23.6,

L24.6, L25.4

Inclusion of Clinical Concepts Underdosing, blood type, blood alcohol level Examples:

T45.526D - Underdosing of antithrombotic drugs, subsequent encounter

Z67.40 - Type O blood, Rh positive Y90.6 - Blood alcohol level of 120-199 mg/100 ml

ICD-10-CM Overview

Code Expansion Injuries, diabetes, substance abuse, postoperative

complications Examples:

E10.610 - Type 1 diabetes mellitus with diabetic neuropathic arthropathy

F10.182 - Alcohol abuse with alcohol-induced sleep disorder

T82.02XA - Displacement of heart valve prosthesis, initial encounter

ICD-10-CM Overview

Postoperative complications Expanded distinction between intraoperative

complications and postprocedural disorders Examples:

D78.01 - Intraoperative hemorrhage and hematoma of spleen complicating a procedure on the spleen

D78.21 - Postprocedural hemorrhage and hematoma of spleen following a procedure on the spleen

ICD-10-CM Overview

Other Changes in ICD-10-CM Injuries grouped by anatomical site rather than by type of

injury Restructuring and reorganization in number of chapters Reclassification for certain diseases to different chapters New code definitions

Definition of acute myocardial infarction is now 4 weeks rather than 8 weeks

ICD-10-CM Overview

Case 1

75-year-old woman receiving continued care for multiple facial lacerations, abrasions, and contusions. She was previously treated in the ER for these injuries.

Case 1

ICD-9-CMV58.89 Encounters for procedures and aftercareICD-10-CMS01.81xD Laceration w/o foreign body of other part of head, subsequent encounterX58.xxxD Accident, NOS, subsequent encounter

Case 2

Patient presents for results of an MRI of the right knee, has severe pain and inability to descend stairs. She fell while running in the park. MRI showed complex medial meniscus tear and a Baker’s cyst, along with mild chondromalacia of the patella. Options for treatment were discussed and the patient will determine what she’d like to do.

ICD-9-CM

836.0 Tear of medical cartilage/meniscus of knee, current

E885.9 Fall on same level from slipping/tripping/stumbling

E849.4 Injury or poisoning occurring at/in place for recreation and sport

E001.1 Activities involving running E000.8 External cause status 727.51 Synovial cyst of popliteal space 717.7 Chondromalacia of patella

ICD-10-CM S83.231A Tear, torn (traumatic) meniscus

(knee) (current injury), medial, complex M71.21 Baker’s cyst – see Cyst, Baker’s M22.41 Chondromalacia (systemic), patella W19.xxxA Index to External Causes – Fall,

falling (accidental) Y92.830 Index to External Causes – Place of

occurrence, park (public) Y93.02 Index to External Causes – Activity

(involving) running Y99.8 Index to External Causes – External

cause status, leisure activity

Case 3

A patient is seen in the hospital with a diagnosis of congestive heart failure due to hypertensive heart disease. The patient responds positively to Lasix therapy. The patient also has chronic kidney disease stage 5.

ICD-9-CM

404.93 Hypertensive heart and chronic kidney disease stage V or end state renal disease, with heart failure, unspecified benign or malignant

585.5 Chronic kidney disease, stage V 428.0 Congestive heart failure, unspecified

ICD-10-CM

I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end state renal disease

I50.9 Heart failure, unspecified N18.5 Chronic kidney disease, stage 5

Case 4

This woman is G1P0 at 39 weeks with twin gestation. The delivery was complicated by nuchal cord, without compression, of fetus 2. Both infants were liveborn and healthy.

ICD-9-CM

651.01 Twin pregnancy, delivered 663.31 Other and unspecified cord

entanglement, without mention of compressions, delivered

V27.2 Mother with twins, both liveborn

ICD-10-CM

O30.003 Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third

O69.81x2 Labor and delivery complicated by cord around neck, without compression, fetus 2

Z37.2 Outcome of delivery, twins, both liveborn

Case 5

55 year old male was admitted for OT following hospitalization for type I open traumatic fracture of the left radius and ulna.

ICD-9-CM

V57.21 Encounter for Occupational Therapy

V54.12 Aftercare for healing traumatic fracture of lower arm

ICD-10-CM

S52.92xE Fracture, traumatic, radius S52.202E Fracture, traumatic, ulna X58.xxxD Index to External Cause,

accident

Case 6

This type 1 diabetic patient has a severe chronic diabetic left foot ulcer with diabetic peripheral angiopathy. He also has diabetic stage 2 chronic kidney disease. He is being evaluated to see if debridement is required for this ulcer with breakdown of the skin.

ICD-9-CM

250.81 Diabetes mellitus with specified manifestation, type I (juvenile type), not stated as uncontrolled

707.15 Ulcer of foot (toes) 250.71 Diabetes mellitus with peripheral circulatory

disorder, type I (juvenile type), not stated as uncontrolled

443.81 Peripheral angiopathy in diseases classified elsewhere

250.41 Diabetes mellitus with renal manifestations, type I (juvenile type), ), not stated as uncontrolled

585.2 Chronic kidney disease, stage II (mild)

ICD-10-CM

E10.621 Type 1 diabetes mellitus with foot ulcerL97.521 Non-pressure chronic ulcer of other

part of left foot limited to breakdown of skin

E10.51 Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene

E10.22 Type 1 diabetes mellitus with diabetic chronic kidney disease

N18.2 Chronic kidney disease, stage 2 (mild)

Mapping between Old & New Systems

34

GEMs Maps

GEMs Maps

= GEMs Crosswalks

ICD-9-CM ICD-10-PCS via CMS web site

ICD-9-CM ICD-10-CM via CMS /NCHS web sites

General equivalence maps (GEMs) between ICD-9-CM and ICD-10-CM/PCS have been

developed

ICD-10 Resources

https://www.cms.gov/ICD10/11b14_2012_ICD10CM_and_GEMs.asp

2012 Code Set, Official Guidelines, GEMS http://www.cms.gov/ICD10