*
Kay Potter, RHIT, CPC, CPC-I, PCS
*ICD – 10
*Keep Calm
*And
*Code On!
*
*Objectives:
*In this section you will learn
Review the basic structure of ICD-10-CM and
differences/similarities to ICD-9-CM.
Describe updates to the ICD-10-CM system
Analyze changes to ICD-10-CM Official
Guidelines for Coding and Reporting
* NCHS is responsible for developing the diagnostic
portion of the ICD-10 coding system, ICD-10-CM.
* CMS is responsible for developing the procedure
portion of the ICD-10 coding system, ICD-10-PCS.
* Who is NCHS?
*
National Center for Health Statistics
compiles statistical information used to guide
actions and policies to improve the public health
U.S. citizens.
*
* Implementation date October 1, 2014
* Partial Code Freeze
* October 1, 2011 – Last regular update to ICD-9-CM
* October 1, 2012 – 2013 – Limited updates to both
ICD-(-CM and ICD-10-CM
* October 1, 2014 – Limited updates to ICD-10-CM,
ICD-9-CM no longer used.
* October 1, 2015 – Regular Updates to ICD-10CM/PCS.
*
* To be used in all settings
* Hospital inpatients
* Hospital outpatients
* Physicians offices
* Emergency offices
* Home Health
* Long Term Care
* Rehabilitation Facilities
* For ANY diagnosis anywhere
*
* As additional detail is to be reported with ICD-10-
CM, more detail will be required in the medical
records from which the data for coding are
extracted.
* For payers, the clarity afforded by the ICD-10-CM
coding system is likely to greatly enhance and assist
in supporting medical necessity.
* With ICD-10-CM, the diagnosis comes significantly
closer to being “married” to the procedure; further,
it intrinsically gives a more complex description of
the condition, thereby leaving less room for denials.
*
* 21 chapters and expanded codes
Some chapters reorganized, some conditions put in to
different chapters
Alphanumeric – first character is always a letter
Addition of up to 7 characters
7th character code extensions in some cases
 Injuries
Initial encounter
Subsequent encounter
Sequela
 Obstetrics
 Glaucoma
*
* Laterality
* __
Example: Acute angle closure glaucoma
* ICD-9-CM
365.22
* ICD-10-CM
H40.211 Right eye
H40.212
Left eye
H40.213
Bilateral
H40.214
Unspecified eye
Increased Specificity

*
External Cause Codes
• Alphanumeric
•
•
•
•
Alpha characters are not case sensitive
I and O are used but only as the 1st character
U is not used – saved for the International version
Restructured chapters

•
Increased specificity and detail

•
E.g. injuries by site and then by type
E.g. laterality – as described
Combination codes

E.g. – Diabetes, Angina, and CAD
*
 Many of the guidelines are exactly the same
between ICD-9-CM and ICD-10-CM
 Conventions
 Format of the Index and Tabular List
 Abbreviations and Punctuation
 NEC, NOS, brackets, and colons etc.
 Steps in assigning codes
 Includes notes
 General coding guidelines
*
SAME
Conventions, general coding guidelines and chapter specific
guidelines
X as a placeholder
7th character
Excludes Notes
-- Excludes 1 – not coded
-- Excludes 2 – not included here
General Coding Guidelines
 Late Effects is now a Sequela
 Laterality
*
Some Differences
* The diagnosis coding system (ICD-10-CM) will
affect both hospital and physician providers .
* In creating the clinical modification for ICD-10
in this country, the National Center for Hospital
Statistics has made significant changes.
* The number of diagnostic codes available for
use in the ICD-10-CM coding system is larger
than the number available in ICD-9-CM by
thousands.
*
* The documentation principles and concepts,
may apply to documentation considerations
created by the impact of both systems.
* ICD-10-CM will pose certain significant
challenges to coders in both physician and
facility settings.
* As additional detail is to be reported with ICD10-CM, more detail will be required in the
medical records from which the data for coding
are extracted.
*
*Never code strictly from the alphabetical
index, always confirm your code choice in
the tabular list to insure the most
appropriate code choice selection.
*ICD 10 has 21 Chapters
*
* The alphabetic Index is divided into sections
and is organized by main terms
* Index of Diseases and Injury
* Index of External Causes of Injury
* Table of Neoplasms
* Table o Drugs and Chemicals
*
*Data Granularity
* Degree or detail contained in data; the fineness
in which data fields are subdivided.
* The increased granularity, or in other words, the
greater level of detail afforded by ICD-10
provides the quality data needed to support the
medical necessity of rendering patient care,
improving clinical outcomes, and improve costeffective disease management.
*
* Combination Code – The term represents a single code
used to classify: two diagnoses, either a diagnosis with an
associated sign or symptom or a diagnosis with an
associated complication.
* IMPORTANT—Multiple codes should not be used when
the classification provides a combination code that
clearly identifies all of the elements documented in the
diagnosis.
*
* Granularity – The term refers to the level of hierarchy
and the amount of information the increased hierarchy
provides to the diagnostic description
*Laterality – ICD-10 code description include right or
left designation.
* The right side is usually character 1,
* Left side character 2.
* Bilateral character is usually 3.
* Unspecified side is either a character 0 or 9, depending on
whether it is a fifth or sixth character.
*
*New – placeholder “X” if the code only has 4 or 5
characters, but needs a 7th character (e.g.,
initial/subsequent/sequela to injury), use an “X” in the
blank spaces
*Different – Exclude 1 (never code it here) and Exclude 2
(not included, if he has that code it separately
*New – Laterality
*New – Coding pregnancy trimesters
*New – Glasgow coma scale
*New – Functional quadriplegia
* Be detailed in your diagnostic documentation:
* Identify laterality
* Identify specific site, anatomical location.
*
*ICD-10-CM Specific
Guidelines for Selected
Chapters
*Thank you for Supporting
*AHIMA!