Learn ICD-10-CM Basics Today and Prepare for the 2013 Implamentation

I
f you are in the medical billing and coding field or you work in medical administration then you are very familiar with the medical coding book, the ICD-9-CM, but what is the ICD-10-CM?

The ICD-10-CM is the replacement for the ICD-9-CM Volumes I and II and the ICD-10-PCS is the replacement for the ICD-9-CM Volume III.

The ICD-9-CM was first published in 1948 and is updated annually to accommodate technological advances, newly discovered diseases, conditions, and disorders, and to delete codes that are obsolete. After decades of revisions the ICD-9-CM codes have become less and less descriptive and room for expansion is no longer available.

The ICD-10-CM and ICD-10-PCS are also used in all developed nations except for the USA. By using an older system than the rest of the world it is also increasingly difficult to compare statistics and track diseases.

Why is this important? Statistics and tracking pulled from these codes allow us to have accurate information that enables us to protect ourselves.

Ex. When an individual is diagnosed and treated for H1N1 they are assigned the ICD-9-CM code 488.1 (while the rest of the developed world assigns a different code from the ICD-10).

In order to track the spread of the disease, the morbidity, and the mortality rate, a report will need to be run and compared for both sets of codes instead of just one.

Switching over to the ICD-10-CM will simplify things in the long run, but in the near future the major structural changes that will be taking place in our physician's offices, hospitals, and insurance companies nationwide may come with a few speed bumps.

Reimbursement disruption can be mineralized by properly preparing now. Becoming educated on code sets, guidelines, new claim forms, and more are imperative.

Although there are several differences between the ICD-9-CM and the ICD-10-CM let's focus on the major ones:

1) Size: The ICD-10-CM is much more comprehensive than the ICD-9-CM. There are almost twice as many catagories and ten times the number of codes (14,025 vs 140,658).


2) Structure: Historically ICD-9-CM codes were always 3-5 digits in length and numeric in nature (with the exception of V and E codes). ICD-10-CM codes are all alphanumeric in nature and can be up to 7 digits in length.


3) Organization: Chapters, catagories, titles, and conditions have all been re-grouped. Ex. ICD-9-CM codes begining with a "0" are grouped under the classification "Infectious and parasitic diseases". ICD-10-CM codes listed under this same classification now begin with A00 through B99.

When comparing the ICD-9-CM to the ICD-10-CM one of the first things you will note is the quantity of codes has expanded significantly. The ICD-9-CM has only 14,025 codes while the ICD-10-CM has 140,658 (as of 2009). This large increase is mainly contributed to two things, technology advancment and increased detail in code descriptions.

The ICD-9-CM was first published in 1948. Since then it has expanded with each annual revision. Old terms, diagnosis, and conditions have become outdated and/or obsolete while technology has grown and new diseases and conditions have been discovered. These two situations coupled together has lead to a decrease in ICD-9-CM code specificity. Since the United States is the last developed nation to implement the ICD-10-CM we also have difficulty comparing our data with other nations.

ICD-10-CM implamentation allows for more specific code descriptions as well as the ability to expand for future use.

C
ode

C
omparison



Ex.1

ICD-9-CM: Code 250.XX - Diabetes Mellitus; 4th digit indicates the complication; 5th digit indicates juvenile or adult onset

ICD-10-CM: E08 - Diabetes due to an underlying disease; E09 - Drug or chemical induced Diabeted; E10 - Type I Diabetes; E11 - Type II Diabetes; E13 - Other specified Diabetes Mellitus; E14 - Uspecified - Each of these 3 digit catagories then has additional digits 4-7 for greater specification.

Ex.2
ICD-9-CM: 880 - Open Wound of Shoulder
880.0 - Without mention of complicaiton
880.1 - Complicated
880.12 - With tendon involvement

ICD-10-CM: S41.0 - Open wound of shoulder
S41.01X - Laceration without foreign body of shoulder
S41.02X - Laceration with foreign body of shoulder

**Final digits in these codes indicate laterality**
1 - Always right side
2 - Always left side
3 - Always Bilateral

One of the biggest differences between the ICD-9-CM and ICD-10-CM is the appearance of the code. Traditional ICD-9 codes were 3-5 digits in length with a decimal point following the 3rd digit and they were typically numeric. ICD-10-CM codes are not only alphanumeric in nature but they can also extend to the 7th digit.

An ICD-10-CM code contains an alpha charecter as its first digit, digits 2 and 3 are numeric, and digits 4-7 can be either alpha or numeric.

Ex. S62.323 - Displaced fracture of shaft of third metecarpal bone, left hand.

Another interresting addition appearing in the ICD-10-CM is the dummy place holder. This place holder uses the letter "X" to hold a position in an exiting code. For example, a code has digits 1-5 and digit 7 available for assignment, but no 6th digit. In this case the "X" would hold the 6th digit's place so the 7th digit can be assigned to the correct position. The missing digits were designed purposely for future expansions.

Ex. T39.8X2 - Poisoning by other nonopioid analgesics and antipyretics, NEC, intentional self harm. (Note: In this instance a fifth digit was not available but a sixth digit was, thus "x" held the fifth digit's place to allow the sixth digit's use.)

**The following is a list of how ICD-10-CM codes are classified according to their three digit catagory**

1.A00-B99: Certain Infectious and Parasitic Diseases
2.C00-D49: Neoplasms
3.D50-D89: Diseases of the Blood and Blood Forming Organs and Certain Disorders Involving the Immune Mechanism
4.E00-E89: Endocrine, Nutritional and Metabolic Disease
5.F01-F99: Mental and Behavioral Disorders
6.G00-G99: Disease of the Nervous System
7.H00-H59: Diseases of the Eye and Adnexa
8.H60-H95: Diseases of the Ear and Mastoid Process
9.I00-I99: Diseases of the Circulatory System
10.J00-J99: Diseases of the Respiratory System
11.K00-K94: Diseases of the Digestive System
12.L00-L99: Diseases of the Skin and Subcutaneous Tissue
13.M00-M99: Diseases of the Musculoskeletal System and Connective Tissue
14.N00-N99: Diseases of the Genitourinary System
15.O00-O9A: Pregnancy, Childbirth, and the Puerperium
16.P00-P96: Certain Conditions Originating in the Perinatal Period
17.Q00-Q99: Congenital Malformations, Deformations, and Chromosomal Abnormalities
18.R00-R99: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, NEC
19.S00-T88: Injury, Poisoning and Certain other Consequences of External Causes
20.V01-Y95: External Causes of Morbidity
21.Z00-Z99: Factors Influencing Health Status and Contact with Health Services

Other structural changes within the ICD-10-CM book include the deletion of hypertension table and additional, revised, and deleted guidelines. The book is still divided into an alphabetic index and a tabular index and still requirse propper look up and cross-referencing.

As with the ICD-9-CM the ICD-10-CM has too many guidelines to discuss individually, so only a few examples are provided here.

What's the Same?

The ICD-10-CM guidelines are located in the front of the book. Traditional conventions are still applicable. Brackets still enclose synonyms words, parentheses still depict nonessential modifiers, and NEC and NOS notations still exist.

There are still "inclusion" notes, sequencing notations (code first / use additional), and "see" or "see also" notes still exist. Acute conditions are still coded before chronic conditions and general coding rules still apply.

What's New?

Exclude notations are now divided into Exclude 1 and Exclude 2 notes. In this case Exclude 1 notes mean "not coded here" and Exclude 2 notes mean "not included here".

For bilateral sites the final code in a code set indicates which side (left/right) is being coded. If the code set does not give a bilateral option two codes must be used, one for each side.

6th and 7th digits are new, so all guidelines pertaining to these are new as well.