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ICD-10-CM. History of ICD-9 World Health Organization (WHO) developed ICD-9 for use worldwide U.S. developed clinical modification (ICD-9-CM) -Implemented

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Text of ICD-10-CM. History of ICD-9 World Health Organization (WHO) developed ICD-9 for use worldwide U.S....

ICD-10-CM

ICD-10-CMHistory of ICD-9World Health Organization (WHO) developed ICD-9 for use worldwideU.S. developed clinical modification (ICD-9-CM)-Implemented in 1979 in U.S.-Expanded number of diagnosis codes-Developed procedure coding system

Why is ICD-9 Being Replaced?Out of date and running out of space for new codes.Approx. 30 years old technology has changedMany categories fullLacks specificity and detailNo longer reflects current medical practice

Why We Need a New Coding System?Reimbursementwould enhance accurate payment for services renderedQualitywould facilitate evaluation of medical processes and outcomes Characteristics Needed in a Coding SystemFlexible enough to quickly incorporate emerging diagnoses and proceduresExact enough to identify diagnoses and procedures precisely

ICD-9-CM is neither flexible nor exact.Reimbursement and Quality Problems With ICD-9-CMExample fracture of wrist-Patient fractures left wrist -A month later, fractures right wristICD-9-CM does not identify left versus rightrequires additional documentation

ICD-10-CM describes -Left versus right -Initial encounter, subsequent encounter-Routine healing, delayed healing, nonunion, or malunion Reimbursement and Quality Problems With ICD-9-CMExample combination defibrillator pacemaker device

Codes for this device are not in the cardiovascular chapter of ICD-9 CM with other defibrillator and pacemaker devices

Coders and researchers have trouble finding these codes with this type of erratic code assignment

ICD-10-PCS provides distinct codes for all these types of devices, in an orderly manner that is easy to findBenefits of Adopting the New Coding SystemIncorporates greater specificity and clinical information and results in:

Improved ability to measure health care servicesIncreased sensitivity when refining grouping and reimbursement methodologiesEnhanced ability to conduct public health surveillance

Decreased denials and decreased need to include supporting documentation with claims

Coding Process Remains the SameICD-10-CM code book retains the same traditional format -Index -Tabular Process of coding is similar-Look up a condition in the Index-Confirm the code in the TabularICD-10, a brief History1990 Endorsed by World Health Assembly (diagnosis only)1994 Release of full ICD-10 by WHO2002 ICD-10 published in 42 languagesImplementation:138 countries for mortality99 countries for morbidity1999 U.S. implemented for mortality (death certificates)Countries Using ICD-10 For ReimbursementUnited Kingdom (1995)Denmark, Finland, Iceland, Norway, Sweden (1994 1997)France (1997)Australia (1998)Belgium (1999)Germany (2000)Canada (2001)ICD-10-CM Major ModificationsAdded trimesters to obstetrical codes (5th digits from ICD-9-CM will not be used)Revised diabetes mellitus codes (5th digits from ICD-9-CM will not be used)Expanded codes (e.g., injury, diabetes)Added code extensions for injuries and external causes of injuriesLaterality Left Versus RightC50.1-Malignant neoplasm, of central portion of breast

C50.111-Malignant neoplasm of central portion of right female breast

C50.112-Malignant neoplasm of central portion of left female breastDifferences Between ICD-9-CM and ICD-10-CMICD 9-CMICD 10-CMApprox. 14,000 codes69,000 codes17 chapters22 chapters3 to 5 characters3 to 7 characters1st character is alpha or numeric1st character is alpha2nd, 3rd, 4th, and 5th characters are always numeric2nd character is always numeric but 3rd through 7th characters can be alpha or numeric Shorter code descriptions because of lack of specificity and abbreviated code titlesLonger code descriptions because of greater clinical detail and specificity and full code titlesComparison of ICD-9-CM and ICD-10-CMICD-9-CM CODEA - Category of codeB - Etiology, anatomical site, and manifestation

ICD-10-CM CODEA - Category of codeB - Etiology, anatomical site, and/or severityC - Extension7th character for obstetrics, injuries, and external causes of injuryABABC15X.ICD-9-CM Code StructureXXXX5E1400VCategoryEtiology, Anatomic Site, Manifestation4Numeric or Alpha (E or V)Numeric3 5 CharactersXXXXCategory.Etiology, Anatomic Site, SeverityAdded code extensions (7th character) for obstetrics, injuries, and external causes of injuryICD-10-CM Structure FormatXXXAMS320.10AAdditional CharactersAlpha (Except U)2 - 7 Numeric or Alpha 3 7 CharactersComparison of ICD-9-CM and ICD-10-CMICD-9-CM CodesICD-10-CM Codes Pressure ulcer codes -9 codes Pressure ulcer codes -125 codesCodes:707.0 Pressure ulcer 707.00 - unspecified site 707.01 - elbow 707.02 - upper back 707.03 - lower back 707.04 - hip 707.05 - buttock 707.06 - ankle 707.07 - heel 707.09 - other siteCode Examples:L89.131 Pressure ulcer of right lower back, stage IL89.132 Pressure ulcer of right lower back, stage IIL89.133 Pressure ulcer of right lower back, stage IIIL89.134 Pressure ulcer of right lower back, stage IVL89.139 Pressure ulcer of right lower back, unspecified stageL89.141 Pressure ulcer of left lower back, stage IL89.142 Pressure ulcer of left lower back, stage IIL89.143 Pressure ulcer of left lower back, stage IIIL89.144 Pressure ulcer of left lower back, stage IVL89.149 Pressure ulcer of left lower back, unspecified stageL89.151 Pressure ulcer of sacral region, stage IL89.152 Pressure ulcer of sacral region, stage IIL89.90 Pressure ulcer of unspecified site, unspecified stage

The codes on the right are only a small set of the 125 potential pressure ulcer codes offered in ICD-10

Pressure ulcer stages 707.2x separate codes (6 codes) , difficult to match up if more than one pressure ulcer18Full Code TitlesICD-9-CM143 Malignant neoplasm of gum143.0Upper gum143.1Lower gumICD-10-CMC03 Malignant neoplasm of gumC03.0 Malignant neoplasm of upper gumC03.1 Malignant neoplasm of lower gumArrangement of Volumes of ICD-10Volume 3: Alphabetical IndexVolume 1: Tabular listVolume 2: Instruction manual

-ICD-9 has 17 chapters-ICD-10 has 22 chapters20END of Part-1