*
Angela R Campbell, RHIA
AHIMA Approved ICD-10-CM/PCS Trainer
Eastern Illinois University
* Differences are in the organization of ICD-10-CM
* ICD-10-CM has the same hierarchical structure as
ICD-9-CM.
* First three characters of the code and all codes
within the same category have similar traits.
*
* ICD-10-CM offers the addition of information
relative to ambulatory and managed care
encounters.
* Conditions that are new or that were not
uniquely identified in ICD-9-CM have been
assigned code numbers in ICD-10-CM.
* In ICD-10-CM, some three-character categories
are not used in order to allow for revisions and
future expansion.
*
* ICD-10-CM codes are alphanumeric and include
all letters except "U”.
* ICD-9-CM’s V and E codes are incorporated into
the main classification in ICD-10-CM.
* The length of codes in ICD-10-CM can be a
maximum of seven characters.
* Injuries grouped by site of the injury, then
type.
* New treatment protocol, new discoveries, new
etiologies listed in a more appropriate chapter.
*
* Grouping of codes
* More complete
descriptions
* Fifth and sixth
characters
* Laterality
* Many categories
* Excludes notes
*
* Use of extensions
* Combination codes
* Terminology used
* Postprocedural
conditions
* Trimester specificity
* New codes
Coding Examples
Laterality
M05.271
Rheumatoid vasculitis
with rheumatoid
arthritis of right ankle
and foot
C50.512
Malignant neoplasm
of lower-outer
quadrant of left
female breast
*
Coding Examples
Combination Codes
K50.812
Crohn’s disease of
both small and large
intestine with
intestinal
obstruction
K71.51
Toxic liver disease
with chronic active
hepatitis with ascites
ICD-9-CM
ICD-10-CM
Three to five characters
Three to seven characters
First character may be alpha (E or V) or
numeric; second thru fifth characters are
numeric
First character alpha, second and third are numeric,
characters 4 – 7 can be alpha or numeric
Limited space for adding new codes
Flexible for adding new codes
Lacks detail
Very specific
Lacks laterality
Has laterality
Addition of a sixth character in some chapters
Addition of code extensions (seventh character) for
obstetrics, injuries and external causes of injuries
Addition of dummy place holder (x)
Includes full code titles for all codes (no reference
back to common fourth and fifth digits)
*
ICD-9-CM Format
ICD-10-CM Format
X
Extension
Category
Etiology,
manifestation,
site
Etiology,
Severity,
site
ICD-10-CM Example
S
5 2 . 1 3 1 a
Displaced fracture of neck of right radius, initial encounter for closed fracture
*
*
Categories
Section Titles
Categories
710 – 719
720 – 724
725 – 729
Arthropathies and Related Disorders
Dorsopathies
Rheumatism, Excluding the Back
Osteopathies, Chondropathies, and
Acquired Musculoskeletal Deformities
M00 - M02 Infectious arthropathies
M05 - M14 Inflammatory polyarthropathies
M15 - M19 Osteoarthritis
730 – 739
M20 - 25
Blocks
Other joint disorders
M96
Dentofacial anomalies (including malocclusion) and
other disorders of the jaw
Systemic connective disorders
Deforming dorsopathies
Spondylopathies
Other dorsopathies
Disorders of the muscles
Disorders of synovium and tendon
Other soft tissue disorders
Disorders of bone density and structure
Other osteopathies
Chondropathies
Other disorders of the musculoskeletal system and
connective tissue
Intraoperative and postprocedural compilations and
disorders of musculoskeletal system, not elsewhere
classified
M99
Biomechanical lesions, not elsewhere classified
M26 - M27
M30 - M36
M40 - M43
M45 - M49
M50 - M54
M60 - M63
M67 - M67
M70 - M79
M80 - M85
M86 - M89
M91 - M94
M95
* Category 274, Gout in ICD-9-CM Chapter 3, Endocrine,
Nutritional and Metabolic Diseases and Immunity
Disorders
* M10, Gout, ICD-10-CM Chapter 13.
* Code 268.2, Osteomalacia, unspecified in ICD-9-CM
Chapter 3
* M83, Adult osteomalacia in ICD-10-CM Chapter 13.
* Code 524.4 Malocclusion, unspecified in ICD-9-CM
Chapter 9, Diseases of the Digestive System
* M26.4, Malocclusion, unspecified in ICD-10-CM Chapter 13.
* Code 526 Diseases of the jaw in ICD-9-CM Chapter 9
* Moved to Chapter 13
*
Inflammatory Polyarthropathies (M05 – M14)
This section includes subcategories for:
* Rheumatoid lung disease with rheumatoid arthritis (M05.1)
* Rheumatoid vasculitis with rheumatoid arthritis (M05.2)
* Rheumatoid heart disease with rheumatoid arthritis (M05.3)
* Rheumatoid myopathy with rheumatoid arthritis (M05.4)
* Rheumatoid polyneuropathy with rheumatoid arthritis (M05.5)
* Rheumatoid arthritis with involvement of other organs and systems (M05.6)
* Rheumatoid arthritis with rheumatoid factor without organ or systems
involvement (M05.7)
* Other rheumatoid arthritis with rheumatoid factor (M05.8)
* Rheumatoid arthritis with rheumatoid factor, unspecified (M05.9)
*
* A initial encounter for fracture
* B subsequent encounter for fracture with routine
healing
* G subsequent encounter for fracture with delayed
healing
* K subsequent encounter for fracture with nonunion
* P subsequent encounter for fracture with malunion
* S sequelae
*
* The following must also be coded in addition to
the type of fracture:
* Place of occurrence code
* Activity code
* Displaced vs. non-displaced
* Type of fracture
* Site of fracture
* Laterality
*
Other changes to this chapter include:
* Postoperative complications have been moved to procedure-specific
body system chapters.
* Pyogenic arthritis is now classified by organism, specific site, and
laterality.
* Rheumatoid arthritis has 191 code options by type, manifestation,
and laterality.
* Osteomyelitis is now classified by type, acuity, specific site, and
laterality.
* Osteoarthritis is now classified by type, specific site, and laterality.
* Systemic Lupus Erythematosus (SLE) is now classified by etiology or
manifestation.
* Scoliosis is classified by type and anatomical region of spine.
* Pain in the limb, which had only one code option in ICD-9-CM, now
has 31 code options based on specific site and laterality.
*
* ICD-10-CM groups injuries
* first by specific site (e.g., head, arm, leg),
* then by type of injury (e.g., fracture, open
wound).
*
* Greater level of specificity in code selection
* Coders need detailed progress notes
* Detailed notes equal less inquires
* Reduction in A/R and claims turnaround
Pressure Ulcers
ICD-9-CM
ICD-10-CM
707.00 – 709.09 – broad location
L89.131 – Pressure ulcer of right lower back, Stage I
L89.132 – Pressure ulcer or right lower back, Stage II
L89.133 – Pressure ulcer or right lower back, Stage III
L89.141 – Pressure ulcer of left lower back, Stage I
L89.149 – Pressure ulcer of left lower back,
unspecified stage
*
Asthma
ICD-9-CM
ICD-10-CM
493.00 – 493.92 – code range
J45.20 – J45.998 note large
expansion of codes
-
-
extrinsic vs. intrinsic
chronic obstructive asthma
with status asthmaticus
with exacerbation
exercise induced bronchospasm
cough variant asthma
mild intermittent
mild persistent
moderate persistent
severe persistent
with status asthmaticus
with exacerbation
exercise induced bronchospasm
cough variant asthma
excludes chronic obstructive asthma
* E codes now Y or V categories
* V codes were replaced by Z codes
* Represent reasons for encounters other than
disease
* BMI located in this section Z68
* Pediatric and adult codes
*
* ICD-10-CM and ICD-10-PCS
* October 1, 2014
* Date of discharge for inpatient claims
* Date of service for outpatient claims
* HHS had stated the date will not be extended.
*
* Coding errors
* Backlog of claims
* Change in documentation requirements
* Superbills – expansion to accommodate
increased codes, may require alternative
* Confusion and possible slow claims transactions
with claims administrators
*
* Coding professionals
* Physicians
* Other healthcare professional
* Nonphysician clinicians/ancillary department personnel
* Utilization management personnel
* Software vendors
* Information systems personnel
* Billing/accounting personnel
* Compliance officers
* Fraud investigators
* Government agency personnel
*
* Staff
* Professional Organizations
* World Health Organization
* Software Vendors
* EMR, Encoders/Coding solutions
* Industry specific organizations
* Journals/Magazines
* Universities/Community Colleges
* Consultants
*
* World Health Organization (WHO)
* http://www.who.int/classifications/icd/en/
* Centers for Medicare and Medicaid Services
(CMS) (2 free modules, CME credit)
* http://www.cms.gov/Medicare/Coding/ICD10/in
dex.html?redirect=/icd10
* Centers for Disease Control and Prevention
(CDC)
* http://www.cdc.gov/nchs/icd/icd10.htm
* U.S. Department of Health and Human Services
* http://www.hrsa.gov/healthit/toolbox/webinars
/pdfs/icd10.pdf
*
* American Health Information Management
Association (AHIMA)
* http://www.ahima.org/icd10/
* AAPC
* http://www.aapc.com/icd-10/
* For the Record Magazine
* http://www.fortherecordmag.com
* Health Data Management
* http://www.healthdatamanagement.com/
* Healthcare IT News
* http://www.healthcareitnews.com/
* HIMSS
* http://www.himss.org/library/icd-10/playbook
* ICD10Monitor
* http://ICD10Monitor.com
* ICD-10 Education (Free webinars, readiness
assessments)
* http://www.icd10-education.com/
* ICD 10 Watch
* http://www.icd10watch.com/
* Step 1 – Impact Analysis: 3 – 6 months
* Step 2 – Contact your Vendors: 2 – 3 months
* Step 3 – Contact your Payers, Billing Service
and Clearinghouse: 2 – 3 months
* Step 4 – Installation of Vendor Upgrades: 3 – 6
months
* Step 5 – Internal Testing: 2 – 3 months
*
* Step 6 – Update Internal Processes: 2 – 3
months
* Step 7 – Conduct Staff Training: 2 – 3 months
* Step 8 – External Testing with
Clearinghouses, Billing Service, and Payers: 6
– 9 months
* Step 9 – Make the Switch to ICD-10: October
1, 2014
* After October 1, 2014
* General Equivalence Mappings
* Developed for specific, limited short-term need
* Reference mappings
* Not a substitute for using/learning ICD-9-CM and
ICD-10-CM/PCS
* Links concepts without consideration of context
or encounter information
* Two GEM files available allowing for bidirectional
mappings.
* ICD-9-CM to ICD-10-CM
* ICD-10-CM to ICD-9-CM
*
* Basic conventions are the same
* All letters used in alphabet with exception of U
* Be careful in writing a zero vs. and “o”, or an “I” vs.
one.
* Read, read, read, notes at the beginning of each
chapter – the only way to become familiar with
guideline changes
* ICD-10-CM will allow comparison of mortality and
morbidity data
* Incorporates much greater specificity and clinical
information
*