ICD-10 Are You Ready?
March 4, 14, and 18
Pat Shaw, EdD(c), RHIA, FAHIMA
AHIMA Approved ICD-10-CM/PCS Trainer
Why Does ICD-9-CM Need to Be
Replaced?
30 years old
Terminology and classification of some conditions are
outdated and obsolete
Outdated codes produce inaccurate and limited data
Increasing lack of specificity
Comparison with international data is hindered
Cannot support transition to interoperable health data
exchange
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ICD-9-CM vs. ICD-10-CM
Similarities
Same hierarchical structure
Same conventions/notes/instructions
Availability of “not otherwise specified” and “not
elsewhere classified” options
Differences
Structural changes
Organizational revisions
New features
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Differences in ICD-10-CM
Alphanumeric (alpha characters are not case-sensitive)
Some chapters have been restructured
Certain diseases have been reclassified to reflect current
medical knowledge
New features have been added
Specificity and detail have been significantly expanded
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ICD-10-CM
Structural Changes
21 chapters
Full code titles for all codes (no references back to
common 4th and 5th digits)
Addition of 6th and 7th characters in some chapters
Added code extensions (7th character) for obstetrics,
injuries, and external causes of injury
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ICD-10-CM
Structural Changes
Addition of dummy place holder (“x”)
Dummy place holder “x”
Used as 5th character for some 6 character codes
For future expansion
Example:
T51.0x1A Toxic effect of ethanol,
accidental (unintentional), initial
encounter
X11.1xxA Contact with running hot water, initial encounter
W00.0xxD Fall on same level due to ice and snow,
subsequent encounter
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2
2nd Numeric
3rd – 7th Numeric or Alpha
1st - Alpha
(Except U)
M
X X
A
S
0 X
2
.
Category
Additional
Characters
X
6 X
5 X
A
X
Etiology, anatomic
site, severity
Added seventh
characters for
obstetrics,
injuries, and
external causes of
injury
3 – 7 Characters
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© 2014
ICD-10-CM
Full Code Titles
ICD-9-CM
143 Malignant neoplasm of gum
143.0
Upper gum
143.1
Lower gum
ICD-10-CM
C03 Malignant neoplasm of gum
C03.0 Malignant neoplasm of upper gum
C03.1 Malignant neoplasm of lower gum
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ICD-10-CM
New Features
Combination codes for conditions and common symptoms
or manifestations
Combination codes for poisonings and external causes
Added laterality
Expanded codes (injury, diabetes, alcohol/substance abuse,
postoperative complications)
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ICD-10-CM New Features
Inclusion of trimester in obstetrics codes (and
elimination of 5th digits for episode of care)
Revised diabetes mellitus codes to reflect current
ADA classification
Changes in time frames specified in certain codes
External Cause codes no longer a supplementary
classification
Added standard definitions for two types of
Excludes notes
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ICD-10-CM
Excludes Notes
Excludes1
Means NOT CODED HERE
Code being excluded is never used with code
The two conditions cannot occur together
Example:
B06 Rubella [German measles]
Excludes1: congenital rubella (P35.0)
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ICD-10-CM
Excludes Notes
Excludes2
Means NOT INCLUDED HERE
Excluded condition is not part of the condition
represented by the code
Acceptable to use both codes together if patient has
both conditions
Example:
J04.0 Acute laryngitis
Excludes2: chronic laryngitis (J37.0)
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ICD-10-CM
Injury Changes
ICD-9-CM
Fractures (800-829)
Dislocations (830-839)
Sprains and strains(840-848)
ICD-10-CM
Injuries to the head (S00-S09)
Injuries to the neck (S10-S19)
Injuries to the thorax (S20-S29)
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ICD-10-CM
Examples – Code Extensions
S31.623A
Laceration with foreign body of abdominal
wall, right lower quadrant with penetration into
peritoneal cavity, initial encounter
S49.011D
Salter-Harris Type I physeal fracture of
upper end of humerus, right arm, subsequent
encounter for fracture with routine healing
S49.011G
Salter-Harris Type I physeal fracture of upper end of
humerus, right arm, subsequent encounter for
fracture with delayed healing
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ICD-9-CM
Open Wound of Shoulder
880 Open wound of shoulder and upper arm
880.0 Without mention of complication
880.1 Complicated
880.2 With tendon involvement
5th digit for site (shoulder, axillary, upper arm)
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5
ICD-10-CM
Open Wound of Shoulder
Detail for open wounds added at 5th character,
laterality at 6th, and encounter at 7th character:
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ICD-10-CM
Diabetes Mellitus Changes
Updated to reflect current clinical classification of
diabetes
Old classification: insulin-dependent (IDDM), noninsulin-dependent (NIDDM), gestational
New classification: type 1, type 2, due to underlying
condition, drug or chemical induced, other specified
types, gestational
Expanded code descriptions to include diabetes and
manifestation in single code
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ICD-9-CM
Diabetes Mellitus
250.00-250.91 Diabetes mellitus
251.8 Other specified disorders of pancreatic internal
secretion
648.8x Abnormal glucose tolerance complicating
pregnancy, childbirth, or the puerperium
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ICD-10-CM
Diabetes Mellitus - Examples
E09.01
Drug or chemical induced diabetes
mellitus with hyperosmolarity with coma
E10.11
Type 1 diabetes mellitus with
ketoacidosis with coma
E11.40
Type 2 diabetes mellitus with diabetic
nephropathy, unspecified
E13.621
Other specified diabetes mellitus with foot
ulcer
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ICD-10-CM
Diabetes Mellitus - Examples
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ICD-9-CM
Decubitus Ulcer
707.00-707.09 Decubitus ulcer
Site-specific codes
No laterality
No differentiation by severity
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ICD-10-CM
Decubitus Ulcer
L89.001-L89.94 Decubitus ulcer
Site-specific codes
Includes laterality
Includes severity (depth)
Limited to breakdown of skin, fat layer exposed, necrosis
of muscle, necrosis of bone
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ICD-10-CM Decubitus Ulcer
ICD-10-CM
Obstetrics
Addition of trimester and deletion of episode of
care
O15.02 Eclampsia in pregnancy, second
trimester
O60.3 Preterm labor, third trimester
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ICD-10-CM
Obstetrics
Trimester also identified in “encounter for supervision of
normal pregnancy codes” Z34.00-Z34.93)
Encounter for supervision of high-risk pregnancy has been
moved to OB chapter
Weeks of Gestation – Category Z3A
Identifies the specific week of pregnancy
ICD-10-CM
Obstetrics
Definition changes
Abortion vs Fetal Death
20 weeks instead of 22 weeks
Early vs late vomiting
20 weeks instead of 22
Preterm labor
37 completed weeks of gestation
ICD-10-CM
Obstetrics
Code extensions to identify specific fetus (1-5)
affected by obstetric condition
Elective, legal, or therapeutic abortions are not
classified to the abortion codes (code Z33.2,
Encounter for elective termination of pregnancy)
Obstructed labor codes incorporate reason for
obstruction
Additional codes for OB complications
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ICD-9-CM
Postoperative Complications
Heart failure following cardiac surgery
429.4 Functional disturbances following cardiac surgery
997.1 Cardiac complications
Use additional code to identify complication
Postoperative intestinal obstruction
997.4 Digestive system complications
Use additional code to identify complication
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ICD-10-CM
Postoperative Complications
Heart failure following cardiac surgery
Postoperative intestinal obstruction
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ICD-10-CM
Symptoms, Signs, Abnormal Findings
Symptom chapter is limited to signs/symptoms
that are “not otherwise specified,” “unknown
etiology,” or “transient”
Signs/symptoms that point to diagnoses are
assigned to relevant chapter
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ICD-10-CM
Reason for Encounter
Personal history of malignant neoplasm
Primary
Secondary
In situ (breast only)
Uncertain behavior
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ICD-10-CM
Reason for Encounter
Presence of artificial joint
By site
Laterality
Case 1
75-year-old woman receiving continued care for multiple
facial lacerations, abrasions, and contusions. She was
previously treated in the ER for these injuries.
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Case 1
ICD-9-CM
V58.89 Encounters for procedures and aftercare
ICD-10-CM
S01.81xD Laceration w/o foreign body of other part
of head, subsequent encounter
X58.xxxD Accident, NOS, subsequent encounter
Case 2
Patient presents for results of an MRI of the right knee,
has severe pain and inability to descend stairs. She fell
while running in the park. MRI showed complex medial
meniscus tear and a Baker’s cyst, along with mild
chondromalacia of the patella. Options for treatment
were discussed and the patient will determine what she’d
like to do.
ICD-9-CM
836.0 Tear of medical cartilage/meniscus of knee,
current
E885.9 Fall on same level from
slipping/tripping/stumbling
E849.4 Injury or poisoning occurring at/in place for
recreation and sport
E001.1 Activities involving running
E000.8 External cause status
727.51 Synovial cyst of popliteal space
717.7 Chondromalacia of patella
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ICD-10-CM
S83.231A Tear, torn (traumatic) meniscus (knee)
(current injury), medial, complex
M71.21
Baker’s cyst – see Cyst, Baker’s
M22.41
Chondromalacia (systemic), patella
W19.xxxA Index to External Causes – Fall, falling
(accidental)
Y92.830 Index to External Causes – Place of
occurrence, park (public)
Y93.02
Index to External Causes – Activity
(involving) running
Y99.8
Index to External Causes – External cause
status, leisure activity
Case 3
A patient is seen in the hospital with a diagnosis of
congestive heart failure due to hypertensive heart
disease. The patient responds positively to Lasix
therapy. The patient also has chronic kidney disease
stage 5.
ICD-9-CM
404.93 Hypertensive heart and chronic kidney disease
stage V or end state renal disease, with heart failure,
unspecified benign or malignant
585.5 Chronic kidney disease, stage V
428.0 Congestive heart failure, unspecified
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ICD-10-CM
I13.2 Hypertensive heart and chronic kidney disease
with heart failure and with stage 5 chronic kidney
disease, or end state renal disease
I50.9 Heart failure, unspecified
N18.5 Chronic kidney disease, stage 5
Case 4
This woman is G1P0 at 39 weeks with twin gestation.
The delivery was complicated by nuchal cord, without
compression, of fetus 2. Both infants were liveborn and
healthy.
ICD-9-CM
651.01 Twin pregnancy, delivered
663.31 Other and unspecified cord entanglement,
without mention of compressions, delivered
V27.2 Mother with twins, both liveborn
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ICD-10-CM
O30.003 Twin pregnancy, unspecified number of
placenta and unspecified number of amniotic sacs,
third
O69.81x2 Labor and delivery complicated by cord
around neck, without compression, fetus 2
Z37.2 Outcome of delivery, twins, both liveborn
Z3A.39 39 weeks of gestation pregnancy
Case 5
55 year old male was admitted for OT following
hospitalization for type I open traumatic fracture of the
left radius and ulna.
ICD-9-CM
V57.21 Encounter for Occupational Therapy
V54.12 Aftercare for healing traumatic fracture of
lower arm
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ICD-10-CM
S52.92xE Fracture, traumatic, radius
S52.202E Fracture, traumatic, ulna
X58.xxxD Index to External Cause, accident
The OT would be captured in the procedure code
Case 6
This type 1 diabetic patient has a severe chronic diabetic
left foot ulcer with diabetic peripheral angiopathy. He
also has diabetic stage 2 chronic kidney disease. He is
being evaluated to see if debridement is required for this
ulcer with breakdown of the skin.
ICD-9-CM
250.81 Diabetes mellitus with specified manifestation, type
I (juvenile type), not stated as uncontrolled
707.15 Ulcer of foot (toes)
250.71 Diabetes mellitus with peripheral circulatory
disorder, type I (juvenile type), not stated as uncontrolled
443.81 Peripheral angiopathy in diseases classified
elsewhere
250.41 Diabetes mellitus with renal manifestations, type I
(juvenile type), ), not stated as uncontrolled
585.2 Chronic kidney disease, stage II (mild)
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ICD-10-CM
E10.621 Type 1 diabetes mellitus with foot ulcer
L97.521 Non-pressure chronic ulcer of other part of left
foot limited to breakdown of skin
E10.51 Type 1 diabetes mellitus with diabetic peripheral
angiopathy without gangrene
E10.22 Type 1 diabetes mellitus with diabetic chronic
kidney disease
N18.2 Chronic kidney disease, stage 2 (mild)
Impact on Specialties
Orthopedic
Injuries, Gustilo classification, encounters, no aftercare
codes for injuries
Obstetrics
Trimesters, weeks of gestation, 7th characters for fetus
Questions
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