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 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Why is ICD-9 Being Replaced?• Out of date and running out of space for new codes.• Approx. 30 years old –technology has changed• Many categories full• Lacks specificity and detail• No longer reflects current medical practice

Why We Need a New Coding System?• Reimbursement–would enhance accurate payment for services

rendered• Quality–would facilitate evaluation of medical processes and outcomes

Characteristics Needed in a Coding System• Flexible enough to quickly incorporate emerging diagnoses and

procedures• Exact 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 wrist

ICD-9-CM does not identify left versus right–requires 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-CM

Example –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 find

Benefits of Adopting the New Coding System• Incorporates greater specificity and clinical information and results in:

–Improved ability to measure health care services

–Increased sensitivity when refining grouping and reimbursement methodologies

–Enhanced ability to conduct public health surveillance

–Decreased denials and decreased need to include supporting documentation with claims

Coding Process Remains the Same• ICD-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 Tabular

ICD-10, a brief History• 1990 –Endorsed by World Health Assembly (diagnosis only)• 1994 –Release of full ICD-10 by WHO• 2002 –ICD-10 published in 42 languages• Implementation:

–138 countries for mortality–99 countries for morbidity

• 1999 –U.S. implemented for mortality (death certificates)

Countries Using ICD-10 For Reimbursement• United Kingdom (1995)• Denmark, Finland, Iceland, Norway, Sweden (1994 –1997)• France (1997)• Australia (1998)• Belgium (1999)• Germany (2000)• Canada (2001)

ICD-10-CM Major Modifications• Added 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 injuries

Laterality –Left Versus Right• C50.1-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 breast

Differences Between ICD-9-CM and ICD-10-CM

ICD – 9-CM ICD – 10-CM

Approx. 14,000 codes 69,000 codes

17 chapters 22 chapters

3 to 5 characters 3 to 7 characters

1st character is alpha or numeric 1st character is alpha

2nd, 3rd, 4th, and 5th characters are always numeric 2nd 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 titles

Longer code descriptions because of greater clinical detail and specificity and full code titles

Comparison of ICD-9-CM and ICD-10-CM

ICD-9-CM CODE• A - Category of code• B - Etiology, anatomical

site, and manifestation

ICD-10-CM CODE• A - Category of code• B - Etiology, anatomical

site, and/or severity• C - Extension

• 7th character for obstetrics, injuries, and external causes of injury

A B

A B C

X .

ICD-9-CM Code Structure

X X X X5E 1 4 0 0V

Category Etiology, Anatomic Site, Manifestation

4

Numeric or Alpha

(E or V) Numeric

3 – 5 Characters

X X X X

Category

.Etiology, Anatomic

Site, Severity

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

ICD-10-CM Structure – Format

X X XAMS 3 2 0. 1 0 A

Additional Characters

Alpha (Except U)

2 - 7 Numeric or Alpha

3 – 7 Characters

Comparison of ICD-9-CM and ICD-10-CMICD-9-CM Codes ICD-10-CM Codes

Pressure ulcer codes -9 codes Pressure ulcer codes -125 codes

Codes: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 site

Code 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

Full Code TitlesICD-9-CM

143 Malignant neoplasm of gum143.0Upper gum143.1Lower gum

ICD-10-CMC03 Malignant neoplasm of gum

C03.0 Malignant neoplasm of upper gumC03.1 Malignant neoplasm of lower gum

Arrangement of Volumes of ICD-10

• Volume 3: Alphabetical Index• Volume 1: Tabular list• Volume 2: Instruction manual

-ICD-9 has 17 chapters-ICD-10 has 22 chapters

END of Part-1