ICD-10-CM Overview and
Presented by: Katherine Abel/Rhonda Buckholtz
2 ICD-10-CM Overview and Coding Guidelines
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• The Health Insurance Portability and
Accountability Act (HIPAA) of 1996
includes provisions for the standardization
of health care information.
Privacy Code Sets
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• ICD-10-CM contains significant
– Expanded injury codes
– Creation of combination diagnosis symptom
– Addition of up to seven-character
– Addition of laterality in code assignment
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• 5010 to be used for
electronic submissions January
• ICD-10-CM to be used for
• ICD-10-PCS to be used
for Inpatient Services
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• ICD-10 was endorsed by the 43rd World
Health Assembly in May 1990
– Came into use in 1994
– ICD has origins into the 1850’s
History of ICD
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• Expanded to include health-related
conditions and to provide greater
specificity at the 6th character level and
with a 7th character extension
• Guidance is found in Official Coding and
Reporting guidelines section of ICD-10-
Characteristics of ICD-10-CM
8 ICD-10-CM Overview and Coding Guidelines
• Differences from ICD-9-CM include:
– Some chapters have been rearranged.
– Some titles have changed.
– Conditions have been regrouped.
– ICD-10 has almost twice as many
categories as ICD-9.
– Minor changes have been made in the
coding rules for mortality.
Format and Structure
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• ICD-10-CM consists of:
– Tabular lists containing cause-of-death titles
and codes, Inclusion and exclusion terms
for cause-of-death titles, Alphabetical index
to diseases and nature of injury
– External causes of injury
– Table of drugs and chemicals description,
guidelines, and coding rules
Format and Structure
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• Combination Codes
• Principal or First-listed diagnosis code
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• All categories are three characters
– The first character of a category is a letter. The second
and third characters may be either numbers or alpha
• Subcategories are either four or five characters.
– Subcategory characters may be either letters or
• Codes are three, four, five, or six characters and the final
character in a code may be either a letter or number.
• Certain categories have 7th character extensions which
may be either a letter or a number.
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• Each chapter begins with three character
Three Character Categories
Chapter 1 Certain
Infectious and Parasitic
• A00–A09 Intestinal
• B15–B19 Viral
Chapter 2 Neoplasms
• C00–C14 Lip, oral
cavity and pharynx
• C51–C58 Female
Chapter 4 Endocrine,
• E08–E14 Diabetes
• E65–E68 Obesity
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• The four character categories further define the
site, etiology, and manifestation or state of the
disease or condition.
– C15 Malignant neoplasm of the esophagus
– C15.3 Malignant neoplasm of upper third of esophagus
– C15.4 Malignant neoplasm of middle third of esophagus
– C15.5 Malignant neoplasm of lower third of esophagus
– C15.8 Malignant neoplasm of overlapping sites of
– C15.9 Malignant neoplasm of esophagus, unspecified
Four Character Categories
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• In ICD-10-CM, a 5th or 6th six character sub-
classifications represents the most accurate level
– J10.8 Influenza due to other influenza virus with other
– J10.81 Influenzal gastroenteritis
– J10.89 Influenza with other manifestations
Five-Six Character Classification
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• Certain ICD-10-CM categories have
applicable seven characters
– The applicable 7th character is required for
all codes within the category, or as the
notes in the Tabular List instruct.
– The seventh character must always be the
7th character in the data field.
Seventh Character Extension
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– T50.B96A Underdosing of
other viral vaccines, initial
– T50.B96D Underdosing of
other viral vaccines,
– T50.B96S Underdosing of
other viral vaccines, sequela
Seventh Character Extension
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• ICD-10-CM utilizes a placeholder
– The “X” is used as a 5th character
placeholder at certain six character codes to
allow for future expansion.
– T15.12XS Foreign body in conjunctival sac,
left eye, sequela
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Locating a Code
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Code First/Use Additional Code Notes
– Etiology/manifestation paired codes have a
specific index entry structure .
– In the index both conditions are listed
together with the etiology code first followed
by the manifestation codes in brackets.
– The code in brackets is always to be
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An alphabetic index entry that states NEC
directs the coder to an “other specified”
code in the Tabular List.
“Not otherwise specified.” This
abbreviation is the equivalent of
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[ ] Brackets are used in the Tabular List to enclose synonyms, alternative
wording, or explanatory wording. Brackets are used in the alphabetic
Index to identify manifestation codes.
( ) Parentheses are used in both the Alphabetic Index and Tabular List to
enclose supplemental words that do not affect the code number.
: Colon is used after an incomplete term that needs one or more of the
modifiers that follow to make it assignable to a given category.
} The brace encloses a series of terms each of which is modified by the
statement appearing at the right of the brace.
, Words following a comma are essential modifiers. The term in the
inclusion note must be present in the diagnostic statement to qualify
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– A “code also” note instructs that two codes may be
required to fully describe a condition, but the
sequencing of the two codes depends on the severity
of the conditions and the reason for the encounter.
“See” and “See Also”
– The “see