ICD-10 Update*
Hematology and Oncology
Blue Cross Blue Shield of Michigan
2014
*NOTE: The information in this document is not intended to impart legal advice. This overview is intended as
an educational tool only and should not be relied upon as legal or compliance advice.
Agenda
• ICD-10 overview
– The mandate
– The differences
– Hematology and Oncology examples
• Hematology and Oncology
– ICD-10 Chapter overviews
– Top diagnostic codes
• Great information…but so what?
• Next steps
• BCBSM readiness
• It’s all about the coding
• Provider Testing
• Appendix – A chapter by chapter look at the ICD-10-CM code
set
2
ICD-10 overview
The ICD-10 Mandate
• The ICD-10 implementation is scheduled for Oct. 1,
2015. On claims with that date of service, all HIPAAcovered health care entities must begin using ICD-10
codes in place of the ICD-9 codes
• Claims with non-compliant codes will be rejected
• Delivered in two parts – ICD-10-CM (for all providers in
all health care settings) and ICD-10-PCS (for hospital
claims and inpatient hospital procedures
• Does not affect CPT or HCPCS codes and usage
4
The differences between ICD-9 and 10
• Differences between the code sets make ICD-10 look
like an entirely different coding language
• Main differences include:
– Volume
– Structure
– New features
5
Volume differences
• About 150,000 ICD-10 codes will replace 17,000 ICD-9
codes
• The greater level of detail in ICD-10 causes the
increased volume
6
Structural differences – ICD-9-CM
7
Structural differences – ICD-10-CM
8
ICD-10-CM New Features
• Combination codes for some conditions and
associated symptoms
• Laterality
• Expansion of some codes
–
–
–
–
Injuries
Diabetes
Alcohol and substance abuse
Post-op complications
• Injuries grouped by anatomical site instead of by
category
9
Examples of Combination Codes – ICD-10-CM
(Hematology: from ICD-10 Chapter 3 – Diseases of the Blood and Blood-forming
Organs and Certain Disorders involving the Immune Mechanism)
• D57.211 – Sickle-cell/Hb-C disease with acute chest
syndrome
• D57.212 – Sickle-cell/Hb-C disease with splenic
sequestration
• D57.411 – Sickle-cell thalassemia with acute chest
syndrome
• D57.412 – Sickle-cell thalassemia with splenic
sequestration
10
Examples of Neoplasm Laterality ICD-10-CM
(Oncology: from ICD-10 Chapter 2 – Neoplasms)
• C34.01 – Malignant neoplasm of right main bronchus
• C34.02 – Malignant neoplasm of left main bronchus
• C44.622 – Squamous cell carcinoma of skin of right
upper limb, including shoulder
• C44.629 – Squamous cell carcinoma of skin of left
upper limb, including shoulder
11
There are other differences
• Code titles are more complete
• Specificity and detail significantly expanded
• Certain diseases reclassified to reflect current
medical knowledge
• The letter “O” should be stated as “O” and not 0(zero)
12
A quick ICD-10-PCS informational overview
• PCS - Procedure Coding System
• Completely different from ICD-9-CM procedure codes
• Codes are built one digit at a time, each digit
represents a different piece of information
• Codes are each 7 characters long (no decimal points)
– Each character can be alpha or numeric except I and
O so as not to be confused with 1 and 0.
• Each codes is built specifically for the procedure
performed so that the coding system is flexible and
allows for new procedures to be easily incorporated
into the coding system.
13
What’s different for Hematology and
Oncology?
Hematology: ICD-10 Chapter 3 Overview
Diseases of the Blood and Blood-forming Organs and Certain
Disorders involving the Immune Mechanism
• Updates include
– Classification improvements
– Code expansions
– Updates to medical terminology
– Greater specificity
• Procedural complications affecting the spleen are included in
chapter 3 of ICD-10-CM.
15
Oncology: ICD-10 Chapter 2
Overview - Neoplasms
Key updates to the Neoplasm chapter include:
• Classification improvements
• Code expansions
- Significant expansion in the malignant neoplasm of male
breast codes
• Revisions to identify laterality for some of the neoplasm sites
• The ICD-10-CM Neoplasm Table is now located at the end of the
Alphabetical index in the code manual and should continue to be
referenced first when coding neoplasms.
.
16
Hematology
Chapter 3 in ICD-10-CM Diseases of the Blood and Blood-forming
Organs and Certain Disorders involving the Immune Mechanism
Top 10 Most Frequently Reported Hematology Diagnoses
ICD-9-CM
ICD-10-CM
285.9 – Anemia
unspecified
D64.9 – Anemia
unspecified
280.9 – Iron deficiency
anemia unspecified
D50.9 – Iron deficiency
anemia unspecified
281.0 – Pernicious
anemia
D51.0 – Vitamin B12
deficiency due to intrinsic
factor deficiency
17
Hematology – Top Ten ICD-10 Codes Cont’d
ICD-9-CM
281.1 – Other vitamin
B12 deficiency anemia
ICD-10-CM
D51.1 – Vitamin B12 deficiency
anemia due to selective vitamin
B12 malabsorption w/proteinuria
D51.2 – Transcobalamin II
deficiency
D51.3 – Other dietary vitamin
B12 deficiency anemia
D51.8 – Other vitamin B12
deficiency anemia
D51.9 – Vitamin B12 deficiency
anemia unspecified
18
Hematology – Top Ten ICD-10 Codes Cont’d
ICD-9-CM
ICD-10-CM
286.9 - Other and
unspecified
coagulation defects
D68.8 – Other specified
coagulation defects
D68.9 – coagulation
defect unspecified
285.21 – Anemia in
chronic kidney
disease
D63.1 – anemia in
chronic kidney disease
19
Hematology – Top Ten ICD-10 Codes Cont’d
ICD-9-CM
287.5 –
Thrombocytopenia
unspecified
ICD-10-CM
D69.6 –
Thrombocytopenia
unspecified
288.60 – Leukocytosis
unspecified
D72.829 – Elevated white
blood cell count
unspecified
280.0 – Iron deficiency
anemia secondary to
blood loss (chronic)
D50.0 – Iron deficiency
anemia secondary to
blood loss (chronic)
20
Hematology – Top Ten ICD-10 Codes Cont’d
ICD-9-CM
288.00 – Neutropenia
unspecified
ICD-10-CM
D70.9 – Neutropenia
unspecified
21
Oncology: ICD-10 Chapter 2 - Neoplasms
Top 10 Most Frequently Reported Oncology Diagnoses Codes
ICD-9-CM
185 - Malignant
neoplasm of prostate
174.9 – Malignant
neoplasm of breast
(female) unspecified
ICD-10-CM
C61 – Malignant neoplasm of
prostate
C50.911 – Malignant neoplasm
of unspecified site of right
female breast
C50.912 – Malignant neoplasm
of unspecified site of left
female breast
C50.919 – Malignant neoplasm
of unspecified site of
unspecified female breast
22
Oncology – Top Ten ICD-10 Codes Cont’d
ICD-9-CM
211.3 – Benign neoplasm
of colon
ICD-10-CM
D12.0 – Benign neoplasm of
cecum
D12.1 – Benign neoplasm of
appendix
D12.2 – Benign neoplasm of
ascending colon
D12.3 – Benign neoplasm of
transverse colon
D12.4 – Benign neoplasm of
descending colon
D12.5 – Benign neoplasm of
sigmoid colon
D12.6 – Benign neoplasm of
colon unspecified
K63.5 – Polyp of colon
23
Oncology – Top Ten ICD-10 Codes Cont’d
ICD-9-CM
162.9 – Malignant
neoplasm of bronchus and
lung unspecified
ICD-10-CM
C34.90 – Malignant
neoplasm of
unspecified part of
unspecified bronchus
or lung
C34.91 – Malignant
neoplasm of
unspecified part of
right bronchus or lung
C34.92 – Malignant
neoplasm of
unspecified part of left
bronchus or lung
24
Oncology – Top Ten ICD-10 Codes Cont’d
ICD-9-CM
ICD-10-CM
238.2 – Neoplasm of
uncertain behavior of skin
D48.5 – Neoplasm of
uncertain behavior of skin
153.9 – Malignant
neoplasm of colon
unspecified
C18.9 – Malignant
neoplasm of colon
unspecified
25
Oncology – Top Ten ICD-10 Codes Cont’d
ICD-9-CM
202.80 – Other malignant
lymphomas unspecified
site extranodal and solid
organ sites
This ICD-9-CM code maps to
17 possible ICD-10-CM codes
ICD-10-CM
C82.50 – Diffuse follicle center lymphoma unspecified site
C82.59 – Diffuse follicle center lymphoma extranodal and solid
organ sites
C84.90 – Mature T/NK-cell lymphomas unspecified ,unspecified
site
C84.99 – Mature T/NK-cell lymphomas ,unspecified, extranodal
and solid organ sites
C84.A0 – Cutaneous T-cell lymphoma ,unspecified, unspecified
site
C84.A9 – Cutaneous T-cell lymphoma unspecified extranodal
and solid organ sites
C84.Z0 – Other mature T/NK-cell lymphomas unspecified site
C84.Z9 – Other mature T/NK-cell lymphomas extranodal and
solid organ sites
C85.10 – Unspecified B-cell lymphoma unspecified site
C85.19 – Unspecified B-cell lymphoma extranodal and solid
organ site
C85.20 – Mediastinal (thymic) large B-cell lymphoma
unspecified site
C85.29 – Mediastinal (thymic) large B-cell lymphoma
extranodal and solid organ site
C85.80 – Other specified types of non-Hodgkin lymphoma
unspecified site
C85.89 – Other specified types of non-Hodgkin lymphoma
extranodal and solid organ sites
C85.90 – Non-Hodgkin lymphoma unspecified unspecified site
C85.99 – Non-Hodgkin lymphoma unspecified extranodal and
solid organ sites
C86.4 – Blastic NK-cell lymphoma
Oncology – Top Ten ICD-10 Codes Cont’d
ICD-9-CM
216.5 – Benign
neoplasm of skin of
trunk except scrotum
174.8 – Malignant
neoplasm of other
specified sites of female
breast
ICD-10-CM
D22.5 – Melanocytic nevi of trunk
D23.5 – Other benign neoplasm
of skin of trunk
C50.811 – Malignant neoplasm
of overlapping sites of right
female breast
C50.812 – Malignant neoplasm
of overlapping sites of left female
breast
C50.819 – Malignant neoplasm
of overlapping sites of
unspecified female breast
27
Oncology – Top Ten ICD-10 Codes Cont’d
ICD-9-CM
203.00 – Multiple
myeloma without
mention of having
achieved remission
ICD-10-CM
C90.00 – Multiple
myeloma not having
achieved remission
28
Great information…but so what?
Everyone has different views of ICD-10
• Clinician Perspective: ICD-10 is understanding the
increased level of detail needed in the medical record
documentation.
• Coder Perspective: Training is required to
understand the additional detail in the codes.
• Payer Perspective: Make sure that our systems can
take the submitted codes and pay claims/apply
benefits appropriately.
The best way to understand the impact of the ICD-10
code set is to see it in action…
30
Real-world examples – Many to one
• Just because there is a significant increase in detail,
it doesn’t mean that all codes have expanded.
• In some cases, the number of codes have been
reduced
– Hypertension changed from malignant, benign, or
unspecified in I-9 to essential hypertension in I-10
31
BCBSM’s lessons learned about the ICD-10CM code set
• Some chapters of codes included significant changes
to the axis of classification (or other factors) which
increased our review time.
• These include:
– OB chapter: Change from episode of care to trimester
– Injury/Poisoning and Other Consequences of External
Causes: Addition of 7th character to identify type of
fracture (open, closed, etc.) and episode of care (initial,
subsequent or for sequela)
• See the appendix for more information about each
chapter and the changes
32
Important points from an industry
perspective
• ICD-10 most likely will increase the need for certified
coders
– This is due to the increased detail in the code set,
especially during the initial months of the transition
• Entities must take into consideration external factors
(such as impacts of Health Care Reform and
requirements of Medicare and Medicaid) when
planning for ICD-10
• A maintenance process must be in place as part of a
long-term solution to enable processing of codes
– How do you update the codes today?
– With increased volume, that process will likely have to
change
33
Medical records – A call for detail
Because of ICD-10 specificity, provider documentation must change to meet the
new level of detail. For example…
Diagnosis:
•
•
•
•
•
Obesity must be specified in ICD-10 if due to excess calories or if drug
induced.
Angina Pectoris is further classified as unstable angina, angina pectoris with
documented spasm or other forms of angina pectoris.
Asthma is specified as mild intermittent, mild persistent, moderate persistent
and severe persistent.
Tobacco dependence in ICD-9 becomes Nicotine dependence in ICD-10.
The type of nicotine dependence must be documented for coding purposes.
Procedures:
•
•
•
Transfusion of Packed Red Blood Cells need to specify if red blood cells are
fresh or frozen.
Hernia repairs require the device (graft/implant) to be coded to autologous
tissue substitute, synthetic substitute or nonautologous tissue substitute.
Radiological procedures (aortogram, arteriography performed under
fluoroscopy) need to specify contrast material used (High Osmolar, Low
Osmolar or other contrast)
34
Why you should care about the ICD-10
transition
If we receive non-compliant codes (problem in the provider space) OR
incorrectly associate ICD-10 diagnosis codes in our systems (problem
in the payer space)…. then there is major disruption…and if there’s
disruption…
Provider has to
call the payer
Payer answers
questions,
requests other
information
Claims are
delayed
Disruption in
cash flows
No one is happy
It is in everyone’s best interest to work toward a seamless transition
35
Next steps
What can others do?
Next steps to prepare for ICD-10*
Learn about the ICD-10 code set
Determine Impact
Identify all places within your organization that use
ICD-9 codes and understand the impact of the
transition
Determine strengths and weaknesses in medical
record documentation
Staff review and refresh medical terminology
Identify training needs
Reach out to others
Plan for coder training (6-9 months prior to
implementation)
Talk to business partners about ICD-10 readiness
(payers, vendors, billing services, etc.)
Be sure to discuss testing capabilities
*Information from CMS’ MLN Matters, SE1019
37
ICD-10 readiness tactics
• Start recoding the superbill and determine the
documentation required to code accurately
– Diabetes: Type 1 or 2, due to underlying condition,
drug/chemical induced
– Manifestations now included in chapter, but some will
need an additional code
– Do you need to expand the superbill based on
physician activities?
• Start with the CMS GEMs
– They will get you in the ball park
– The GEMs list all possible code combinations
• Where else do ICD-9 codes exist in your office?
• Talk to your specialty societies and ask if there is a
plan to provide you with a list of conversion codes
• Training: coding classes, refresher on medical
terminology (many terms have been updated in I-10),
and anatomy and physiology
38
ICD-10 Implementation Resources
•
•
•
•
•
•
•
•
•
CMS.gov provider resources link:
 http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html
CMS.gov provider implementation timelines and checklists link:
 http://www.cms.gov/Medicare/Coding/ICD10/ICD-10ImplementationTimelines.html
CMS.gov ICD-10 basics for medical practices link:
 http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10_Basics_for_Medical_Practices_060413[1].pdf
American Hospital Association - AHA.org website link:
 http://www.ahaphysicianforum.org/webinar/2013/icd-10/index.shtml
Specialized training resources (extra cost): American Health Information Association – AHIMA.org and American
Association Professional Coders – AAPC.com links:
 http://ahima.org/ContinuingEd/Campus/courseinfo/ICD10.aspx
 http://www.aapc.com/icd-10/
Coding Tipsheets - AHIMA.org and Californiahia.org links:
 http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_049431.hcsp?dDocName=bok1_049431#c
 http://www.californiahia.org/icd-10-cmpcs
American Medical Association – AMA.org website links:
 http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billinginsurance/hipaahealth-insurance-portability-accountability-act/transaction-code-set-standards/icd10-codeset.page
BCBSM website – BCBSM.com and provider readiness mailbox links:
 http://www.bcbsm.com/content/public/en/providers/help/faqs/icd-10
 icd-10providerreadiness@bcbsm.com
Check with your professional and medical associations about ICD-10 readiness.
39
ICD-10 Implementation Resources
Professional Resources
•
If you’re having trouble getting started with your ICD-10
implementation, the American Association of Professional Coders
(AAPC) has a great, free way to start you on your way.
•
By accessing the AAPC ICD-10 coding crosswalk, you can start your
practice off on the right foot to having the information you need.
•
A free .pdf copy is available by going to this website link:
http://www.aapc.com/ICD-10/crosswalks/pdf-documents.aspx and
providing some basic contact information.
– Once you submit your information, a list of specialties will be displayed and
you will be able to download the free .pdf for any of the specialties you
choose. The Crosswalk contains the top 50 ICD-9 codes and the
corresponding ICD-10 codes and is especially useful for the most commonly
defined diagnosis codes.
BCBSM readiness
Upcoming major activities
2014-2015
2012-2013
2011
2009 to 10
Strategy,
planning and
mapping
methodology
Technical
changes,
mapping the
codes and
financial
neutrality
External testing
and
Implementation
Technical coding,
neutrality, testing
provider
readiness,
business
readiness
42
Steps we are taking to minimize the risk of
disruption
• Choose a solution that allows us to transition and
positions us for possible contingencies
– Extension of ICD-10 deadline
– Request to accept both ICD-9 and ICD-10 codes for a
time period
• Extensive testing plan
• Outreach and communications
• Internal training of staff
43
It’s all about the coding
ICD-10 and appropriate coding
• When you think about it – ICD-10 is another example
of appropriate coding
• This is not up-coding
• Rather it’s about following national coding guidelines
and making sure to accurately describe a patient’s
condition
• Here are some important notes about appropriate
coding
– Valid signatures are needed in medical records
– Specificity in medical record notes, especially for ICD10-CM, is essential
– It’s important to code claims with accurate level of
specificity
45
Documentation Tips
For all documented diagnoses, consider the acronym:
M.E.A.T.
Include details on how you either:
–
–
–
–
Manage/Monitor the condition
Evaluate the condition
Assess the condition
Treat the condition
Why appropriate coding is so important to
you
• Ensuring appropriate benefit application and/or
payment (if applicable)
• Helps to reduce the possibility of requests for medical
records
• Could help reduce the instances of medical record
reviews
• Proper coding now will help your practice or facility
deal with the increased detail needed for:
– quality measures
– government programs (such as risk adjustment)
– incentive programs and ACOs
47
For example
• Accurate documentation and coding impacts several
programs:
–
–
–
–
Stars
HEDIS
PQRI (CMS’ Physician Quality Reporting Initiative)
PCMH
48
ICD-10 Provider Testing Options with
BCBSM (updated for 2014)
ICD-10 Testing Options
Testing option
What it tests
What it will tell you
Transactional testing
of claims with ICD-10
codes
The ability to accept
fully compliant 837
transactions with ICD10 codes
Testing
available
through
10/1/2015
Send an e-mail to:
Icd-10claimstesting@bcbsm.com
If you’re interested in external claims
testing.
Medical scenario
testing – professional
A medical scenario is
presented (by
specialty) and the
submitter is asked to
assign appropriate
ICD-10 codes
Whether or not a
claim with an ICD-10
code was received
and passed EDI
compliance checks

What codes
were submitted

What other
health care
providers of the
same specialty
submitted for
that scenario
Testing
available
through
10/1/2015
Use this link (copy and paste to your
internet browser) to register for medical
scenario testing for professionals:
http://bcbsmicd10providerregistry.hi
ghpoint-solutions.com

Testing
available
through
10/1/2015
DRG shift testing –
facility
The impact of ICD-10
coding on DRG shifts

ICD-10 codes
submitted
(based on a
historical ICD-9
claim)
Impact of the
ICD-10 codes
on the DRG
assignment
Time line
How to join
Once registered, we will provide
detailed instructions on how to use the
tool will be provided via email.
Send an email to:
icd-10providertesting@bcbsm.com
if you would like to register for facilities
testing.
For the medical scenario testing and the DRG shift testing, we will provide you with background documentation
and detail
Professional Testing with BCBSM
• The test tool is available for use now through the ICD-10
implementation date (Oct. 1, 2015).
• Use of this tool is free of charge.
• Testing is done through the web; no special software or lengthy
test requirements are needed.
• It is “content based” and “specialty specific,” which means that
you will be presented with several medical scenarios and be
asked to code the scenarios in ICD-10.
• Scenarios are based on specialties (internal medicine, oncology,
etc.) and providers must register for each specialty they are
interested in testing.
Professional Testing with BCBSM
Continued
• We recommend you have some familiarity with the ICD-10
codes and have a code book or other access to the code set to
complete this test.
• BCBSM will provide a peer group report of the codes selected
for the same scenarios which can be accessed multiple times as
additional providers participate in the testing.
• To register and begin the ICD-10 professional testing process,
access the following link:
bcbsmicd10providerregistry.highpoint-solutions.com
Facility Testing with BCBSM
• The process will continue through the ICD-10 implementation of
Oct. 1, 2015.
• Use of this tool is free of charge.
• This testing identifies the impact of ICD-10 code selection on
DRG shifts.
• Facilities will register the historical claims which they would like
to include in the test effort.
• BCBSM will validate/register those claims and provide a link to a
web based tool.
Facility Testing with BCBSM
Continued
• Facilities will recode the original medical record and submit the
ICD-10 codes either directly into the tool or via uploading a
spreadsheet with the responses into the tool.
• BCBSM will run the response thru the DRG grouper and provide
a side by side comparison report of how each claim was
grouped using the original ICD-9 codes along with the new ICD10 codes.
• Send an email to icd-10providertesting@bcbsm.com if you
would like to register for facilities testing.
Questions
Appendix A chapter by chapter look at the ICD10-CM code set
(Chapters 2 & 3 overviews previously provided)
Chapter 1 - Certain infectious and parasitic
diseases
• Includes diseases generally recognized as communicable or
transmissible.
• Updates to Chapter 1 of ICD-10-CM include:
– Terminology changes
• Sepsis (ICD-10-CM) has replaced Septicemia (ICD-9-CM)
• Urosepsis is a nonspecific term and is not coded in ICD-10-CM. Should a
provider use this term, he/she must be queried for clarification.
• “Late Effects” of Infectious and Parasitic Diseases (ICD-9-CM) is now
“Sequela” of infectious and Parasitic Diseases in ICD-10-CM
– Coding guideline changes
• Infections resistant to antibiotics requires the use of an additional code for
any associated drug resistance only if the infection code does not identify
drug resistance (Z16 category, resistance to antimicrobial drugs)
– Expansion of the codes to reflect manifestations of the disease.
• Many of the codes are combined conditions and common
symptoms
57
Chapter 4 - Endocrine, nutritional and
metabolic diseases
• Considerable changes were made to the organization,
code expansions and updates to medical terminology in
Chapter 4.
• The largest change noted is to the Diabetes Mellitus
classification.
– ICD-10-CM Diabetes mellitus codes are now combination
codes that include the type of diabetes (1 or 2), the body
system affected and complications affecting the body
system (Retinopathy, Neuropathy, Arthropathy, Peripheral
angiopathy with gangrene, etc.)
– As many codes within a particular category as are
necessary to describe all of the complications of the disease
may be used.
58
Other diabetes changes
• Diabetes Mellitus (E08-E13) is no longer classified as
controlled or uncontrolled in ICD-10-CM. Therefore
this is no longer a factor in the ICD-10-CM code
selection.
• ICD-10-CM classifies inadequately controlled, out of
control, and poorly controlled diabetes mellitus to
diabetes, by type with hyperglycemia.
• Secondary diabetes is always caused by another
condition or event (e.g., cystic fibrosis, malignant
neoplasm of pancreas, pancreatectomy, adverse
effect of drug, or poisoning).
59
Overweight and obesity codes
• The classification for overweight and obesity has been
expanded in ICD-10-CM to include:
– Obesity due to excess calories
– Morbid (severe) obesity due to excess calories
– Other obesity due to excess calories
– Drug induced obesity
– Morbid (severe) obesity due to alveolar
hypoventilation
– Overweight
– Other obesity
– Obesity unspecified
• An additional code (Z68 category) is used to identify
the body mass index (BMI), if known.
60
Chapter 5 - Mental, behavioral and
neurodevelopmental disorders
Updates to Chapter 5 include:
• Classification improvements (different categories)
• Code expansions
– Most notably, Other Isolated or Specific Phobias
• Updates to medical terminology
– Bipolar I disorder, single manic episode will change to Manic
episode
– Undersocialized conduct disorders, aggressive will become
Conduct disorder childhood-onset type
• Other significant changes
– Nicotine dependence updated to identify specific tobacco
products (cigarettes, chewing tobacco, other tobacco)
– Alcohol abuse and dependence codes no longer identify
continuous or episodic use
61
Chapter 6 - Diseases of the nervous system
• ICD-10-CM devotes Chapter 6 to Diseases of the
Nervous System. The sense organs (eye/adnexa and
ear/mastoid processes) have their own chapters in ICD10-CM.
• Updates to Chapter 6 include
– Classification improvements (significant changes to sleep
disorders)
– Code expansions (e.g. Alzheimer’s, headaches)
– Updates to medical terminology (epilepsy, seizures)
62
Chapter 7 - Diseases of the eye and adnexa
• Diseases of the Eye and Adnexa is a new chapter in
ICD-10-CM.
• Key updates to this chapter include
– Terminology improvements (bringing terms up to date)
– Revisions to identify laterality
• ICD-10-CM contains codes for right side, left side and in
some instances bilateral sides for diseases of the eye
and adnexa.
• An unspecified site is also provided should the site not
be identified in the medical record.
• If no bilateral code is provided and the condition is
bilateral, assign separate codes for both the left and right
side.
63
Chapter 8 - Diseases of the ear and mastoid
process
• This is a new chapter in ICD-10, which has been
separated from the Nervous System and Sense
Organs chapter included in ICD-9-CM.
• There is also a greater specificity and detail in the
codes.
• Many codes have laterality designation.
64
Chapter 9 - Diseases of the circulatory
system
• Similar structure to ICD-9-CM, but there are
classification changes to be aware of
• Terminology used to describe several cardiovascular
conditions has been revised to reflect more current
medical practice
• A major change is the classification of hypertension,
which in ICD-9-CM was classified by type: benign,
malignant or unspecified. That classification is not
required in ICD-10-CM. The code for hypertension
has been updated to one code for essential (primary)
hypertension.
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Chapter 10 - Diseases of the respiratory
system
• Modifications have been made to specific categories that
bring the terminology up-to-date with current medical
practice.
– Emphysema now contains codes with panlobular and
centrilobular in their titles
– Asthma is now classified as mild intermittent, mild
persistent, moderate persistent and severe persistent.
• Specificity increased for diseases like influenza, acute
bronchitis
• Coding guidelines updates to require the coder to
include information about tobacco use/dependence,
where applicable.
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Chapter 11 - Diseases of the digestive
system
• A number of new subchapters have been added to
this chapter (including liver diseases)
• Some terminology changes and revisions to the
classification of specific digestive conditions have
occurred in ICD-10-CM as well.
– The term hemorrhage is used when referring to ulcers
– The term bleeding is used when classifying gastritis,
duodenitis, diverticulosis and diverticulitis
• There is new specificity to conditions like Crohn’s
disease, which have been expanded to specify site, if
a complication is present, and what the complication
is.
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Chapter 12 - Diseases of the skin and
subcutaneous tissue
• This chapter has been completely restructured to bring
together groups of diseases that are related to one
another in some way.
• Greater specificity has been added to many of the
codes at the 4th, 5th or 6th character level.
• It has 9 subchapters (compared to 3 in ICD-9-CM)
• There are many changes to the ulcer’s sectionpressure ulcer codes are combination codes that
identify site and stage of the ulcer.
• Procedural complications of the skin and
subcutaneous tissue are included.
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Chapter 13 - Diseases of the musculoskeletal
system and connective tissue
• Most of the codes within this chapter have site and laterality
designations.
• ICD-10-CM identifies three different causes for pathological
fractures; neoplastic disease, osteoporosis, and other specified
disease.
• ICD-10-CM introduces the 7th character that describes type of
encounter or the state of a fracture’s healing and any sequela.
Some of the codes in this chapter have a 7th character applied.
BCBSM Proprietary Document
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Chapter 14 - Diseases of the genitourinary
system
• Procedural complications affecting the genitourinary system are
included in chapter 14.
• Laterality is used to identify conditions under N60 category,
benign mammary dysplasia.
• In some of the categories, specificity is based on the gender of
the patient.
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Chapter 15 - Pregnancy, childbirth and the
puerperium
• Trimester is now the axis of classification rather than the
current episode of care, i.e. delivered, antepartum,
postpartum
– The majority of codes in this chapter have a final character
for trimester of pregnancy (see chart).
Trimesters
1st
Less than 14 weeks 0 days
2nd
14 weeks 0 days to less than 28
weeks 0 days
3rd
28 weeks 0 days until delivery
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Chapter 16 - Certain conditions originating
in the perinatal period
• Codes from this chapter are for use on newborn
records only, never on maternal records and include
conditions that have their origin in the fetal or perinatal
period (before birth through the first 28 days after birth)
even if morbidity occurs later.
• Different codes are used for “light for gestational age”
and “small for gestational age”.
• Codes for assigning birth trauma have been expanded
to include more specificity.
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Chapter 17 - Congenital malformations,
deformations and chromosomal
abnormalities
• Modifications have been made to specific categories
that bring the terminology up-to-date with current
medical practice.
• Other enhancements to Chapter 17 include
classification changes that provide greater specificity
than found in ICD-9-CM.
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Chapter 18 - Symptoms, signs and abnormal
clinical and laboratory findings
• Chapter 18 includes symptoms, signs, abnormal results
of clinical or other investigative procedures, and illdefined conditions regarding which no diagnosis
classifiable elsewhere is recorded.
• Practically all categories in Chapter 18 could be
designated as:
• Not otherwise specified
• Unknown etiology or
• Transient
• There are codes to identify a patient’s coma scale.
• ICD-10-CM contains a number of combination codes
that identify both the definitive diagnosis and common
symptoms of that diagnosis.
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Chapter 19 - Injury, poisoning, and certain
other consequences of external causes
• Injuries grouped by body part rather than category of injury in
ICD-9
• ICD-10-CM introduces a 7th character requirement that
describes the type of encounter. Most categories in this
chapter use the 7th character requirement. Many categories
in this chapter have three 7th character values of:
• A – Initial encounter
• D – Subsequent encounter
• S – Sequela
• For traumatic fractures, there are additional 7th character
requirements depending upon the type of fracture and
complication. Some of these character descriptions are
based on the Gustilo open fracture classification.
• Code for underdosing are new in ICD-10-CM. Underdosing
refers to taking less of a medication than is prescribed by a
provider or less than the manufacturer’s instructions.
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Chapter 20 - External causes of morbidity
• External cause codes are intended to provide data
for injury research and evaluation of injury
prevention strategies.
• These codes capture how the injury or health
condition was caused, the intent, the place where
the event occurred, the activity of the patient at the
time of the event, and the person’s status.
• These codes are secondary codes for use in any
health care setting and can never be a principal (first
listed) diagnosis.
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Chapter 21 - Factors influencing health
status and contact with health services
• These codes are used in any healthcare setting. Z
codes may be used as either a first listed (principal
diagnosis code in the inpatient setting), or secondary
code, depending on the circumstances of the encounter.
Certain Z codes may only be used as first listed or
principal diagnosis in certain conditions- refer to official
coding guidelines.
• Some of the category sections include,contact/exposure,
vaccinations, status code, screening, aftercare
• Aftercare note - In ICD-10-CM Aftercare Z codes should
not be used for aftercare of fractures.
• For aftercare of a fracture, assign the acute fracture
code with the 7th character extension of D for
subsequent encounter.
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