Don’t Be Afraid of ICD-10
Melonie Loutsch, CPC, ACS-EM
April 26th 2014
ICD-10 Delay
• A one-year delay of ICD-10 has been
implemented.
• New target date for ICD-10 is October 1, 2015
• Second time congress has acted to delay ICD10.
The start of ICD
• The classification system started in 1850 and
was known as the International list of cause of
death.
• 1883 the classification system was know as
International Statistical Institute.
• 1948 the World Health Organization (WHO)
took over the responsibility for this
classification system better known as ICD
(International Classification of Disease).
Why Convert to ICD-10 Now?
• ICD-9 has been around since 1978.
• 1990 the WHO endorsed ICD-10 to the world
and many countries adopted it but the United
States.
• Because of the age of ICD-9 it doesn’t
accurately reflect all the advances in medical
technology and medical knowledge.
Why Convert to ICD-10 Now
• ICD-9 is simply running out of codes with no
room for expansion within the current 17
chapters.
• ICD-9 is also lacking the increased specificity
that ICD-10 has.
ICD-10 Specificity
With ICD-10 having higher specificity of codes it is
believed that with more specific data
– I10 will provider better information to identify
diagnosis trends.
– I10 will provider better information for public
health needs.
– I10 will provider better information to
understand epidemic outbreaks.
– I10 will provider better information on how to
deal with bioterrorism events.
ICD-10 Specificity
With I10 having more precise codes we will have
– The potential benefit for fewer rejected
claims.
– Improved benchmarking data.
– Improved quality and care management.
– Improved public health reporting.
Grieving Process of ICD-10
• Denial Stage – This can’t be happening
• Anger Stage – It is not fair what is the
government thinking.
• Bargaining Stage – “Dear Lord if I10 doesn’t
happen I will never complain about work again”.
• Depression Stage – I am never going to be able to
learn this. I’m to old for this.
• Acceptance Stage – I learned ICD-9 I can learn
ICD-10. It is going to be ok.
ICD-10 Not a Simple Update
• ICD-10 is not a simple update to ICD-9 but a
whole fundamental change in the structure
and concepts that make ICD-10 very different
from ICD-9
Comparison Table
ICD-9
3 -5 characters in length
Approximately 16,000 codes
First digit Alpha or Numeric
Limited space for new codes
Lacks detail
Lacks laterality
ICD-10
3 - 7 characters in length
Approximately 68,000 codes
First digit is always a Alpha
Flexible and space for new codes
Very specific
Has laterality
ICD-10 Chapters
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Chapter 1 - Infectious and Parasitic Disease
Chapter 2 - Neoplasms
Chapter 3 – Disease of Blood
Chapter 4 – Endocrine and Nutritional Disease
Chapter 5 – Mental Disorders
Chapter 6 - Disease of Nervous Systems
Chapter 7 – Disease of Eye and Adnexa (new)
ICD-10 Chapters
•
•
•
•
•
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Chapter 8 - Disease of Ear and Mastoid (new)
Chapter 9 – Diseases of Circulatory System
Chapter 10 – Disease of Respiratory System
Chapter 11- Disease of the Digestive System
Chapter 12 – Disease of Skin
Chapter 13- Disease of Musculoskeletal
System
ICD-10 Chapters
•
•
•
•
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Chapter 14 – Disease of Genitourinary System
Chapter 15 – Pregnancy and Childbirth
Chapter 16 – Perinatal Period
Chapter 17 – Congenital and Malformations
Chapter 18 – Symptoms, Signs, and Abnormal
Clinical laboratory findings.
ICD-10 Chapters
• Chapter 19 – External Causes of Injury and
Poisoning
• Chapter 20 – External Causes of Morbidity
• Chapter 21 – Factors Influencing Health Status
and Contact with Health Services.
ICD-10 Code Structure
• Characters 1-3 – Category Codes
• Characters 4-6 – Etiology, anatomic site,
severity, or other clinical detail.
• Character 7 - Extension
Code Structure
S52 - Facture of forearm
S52.5 - Fracture of lower end of radius
S52.52 - Torus fracture of lower end of radius
S52.521 - Torus fracture or lower end of right radius
S52.521A - Torus fracture of lower end of right radius
initial encounter for closed fracture
Gatorgry code/ base code
Anatomical site
Specifity of fracture
Laterality of fracture
Additiona information to
paint a clear picture for the
insurance companies
Documentation Readiness for ICD-10
• Specificity- In ICD-10 they type of tobacco
product being used is part of of the code
choice selection and documentation should
include this
• Clinical Support Documentation – BMI is
coded secondarily to obesity and
documentation needs to include BMI for
proper code choice selection
Be Ready for ICD-10
• Combination Codes – Diabetes Mellitus codes
are now combination codes that include
manifestations requiring documentation of
any manifestation as well as the type of DM.
• Insulin Use – Long term use of insulin is coded
for any Type 2 diabetic patient on insulin.
• Simplification – Immunization coding is
simplified to 1 code.
Be Ready for ICD-10
• Type – Documentation for upper respiratory
infections needs to include acute, chronic, due
to streptococcal or viral NOS in order to assign
the most appropriate code.
• Cause – ICD-10 Obesity is classified due to
drug, excess calories, and then further divided
by morbid and sever.
What do Provider need to do
• Think in ink
• Let your documentation show what you are
treating, managing, or reviewing
• Put it all in ink so that we can code to the
highest specificity.
Team Work
• More now than any other time the medical
tem must work together.
• Clinic, hospital, or nursing home
• With the move from ICD-9 to ICD-10, Meaning
full use, and the ACOS. We need team work
to encourage each other.
Don’t be afraid ICD-10
• Instead of being afraid of ICD-10 we need to
embrace it and forge ahead. It is the same as
trying to eat an elephant. Just take one bit at
a time.