Basic Introduction
to
ICD-10 CM/PCS
ICD-10 Implementation

October 1, 2015 – Compliance date for implementation
of ICD-10-CM (diagnoses) and ICD-10-PCS
(procedures)

ICD-10-CM (diagnoses) will be used by all providers in
every health care setting

ICD-10-PCS (procedures) will be used only for hospital
claims for inpatient hospital procedures
◦ ICD-10-PCS will not be used on physician claims, even those for
inpatient visits
CPT and HCPCs Codes

No impact on Current Procedural Terminology
(CPT) and Healthcare Common Procedure Coding
System (HCPCS) codes

CPT and HCPCS will continue to be used for
physician and ambulatory services including
physician visits to inpatients
ICD-10 Implementation

Single implementation date of October 1,
2015 for all users

Ambulatory and physician services provided
on or after October 1, 2015 will use ICD10-CM diagnosis codes

Inpatient discharges occurring on or after
October 1, 2015 will use ICD-10-CM and
ICD-10-PCS codes
Why ICD-10
Current ICD-9 Code Set is:




Outdated: 30 years old
Current code structure limits amount of new codes
that can be created
Has obsolete groupings of disease families
Lacks specificity and detail to support:
◦ Accurate anatomical positions
◦ Differentiation of risk & severity
◦ Key parameters to differentiate disease manifestations
Diagnosis Code Structure Comparison
ICD-9-CM (Volume 1 & 2)
ICD-10-CM
3-5 characters in length
3-7 characters in length
Approximately 14,000 codes
Approximately 68,000 codes
First digit may be alpha (E or V) or
numeric; digits 2-5 are numeric
Digit 1 is alpha (to indicate the
category);
Digit 2 is numeric (in the future,
alpha characters may be used if
code expansion is needed);
Digits 3-7 can be alpha or numeric
Limited space for adding new codes
Flexible for adding new codes
Lacks detail
Very specific
Lacks laterality
Includes laterality (i.e., codes
identifying right vs. left)
ICD-10-CM (diagnosis) Code Format
Alpha
(except U)
2nd – Always Numeric
3rd-7th Alpha or Numeric
S 3 2
Category
3-7 Characters
Additional
Characters
0 1 0 A
Etiology, Anatomic Site,
Severity
Added code extensions (7th Character) for
obstetrics, injuries and external causes of
injuries
Comparison: ICD-9 to ICD-10
434.11
Cerebral embolism
with infarction
Code represents embolism of
cerebral arteries with infarction
With specificity and laterality,
one ICD-9 code translates into
14 possible ICD-10 codes
I63.40
Cerebral infarction dew to embolism
of unspecified cerebral artery
I63.49
Of other cerebral artery
I63.411
Of right middle cerebral artery
I63.412
Of left middle cerebral artery
I63.419
Of unspecified middle cerebral artery
I63.421
Of right anterior cerebral artery
I63.422
Of left anterior cerebral artery
I63.429
Of unspecified anterior cerebral artery
I63.431
Of left posterior cerebral artery
I63.432
Of right posterior cerebral artery
I63.439
Of unspecified posterior cerebral artery
I63.441
Of right cerebellar artery
I63.442
Of left cerebellar artery
I63.449
Of unspecified cerebellar artery
Procedure Code Structure Comparison
ICD-9-CM (Volume 3)
ICD-10-PCS
3-4 numbers in length
7 alpha-numeric characters in
length
Approximately 3,000 codes
Approximately 87,000 available
codes
Based on outdated technology
Reflects current usage of
medical terminology and devices
Limited space for adding new
codes
Flexible for adding new codes
Lacks detail
Very specific
Lacks laterality
Has laterality
Generic terms for body parts
Detailed descriptions for body
parts
ICD-10-PCS Code Format
S 3 2 0 1 0 A
Section
Root
Operation
Body
System
Approach
Body
Part
Qualifier
Device
Comparison: ICD-9 to ICD-10
ICD-9 Procedure Code
39.50 Angioplasty
39.31 Suture of artery
47.01 Laparoscopic appendectomy
ICD-10 Procedure Code
0DN90ZZ Release of duodenum, open approach
0FB03ZX Excision of liver, percutaneous approach, diagnostic
02PS0CZ Removal, extraluminal device from pulmonary vein,
right, open
ICD-10 Provider Impacts

Clinical documentation is the foundation of successful ICD-10
Implementation

Golden Rule of Documentation
◦
◦

The purpose in documentation is to tell the story of what was
performed and what is diagnosed accurately and thoroughly reflecting
the condition of the patient
◦
◦

what services were rendered and
what is the severity of the illness
The key word is SPECIFICITY
◦
◦

If it isn’t documented by the physician, it didn’t happen
If it didn’t happen, it can’t be billed
Granularity
Laterality
Complete and concise documentation allows for accurate coding
which leads to maximized reimbursement
ICD-10 Changes Everything!

ICD-10 is a Business Function Change, not just another
code set change.

ICD-10 Implementation will impact everyone:
◦ Registration, Nurses, Managers, Lab, Clinical Area, Billing,
Physicians, and Coding.

Know your role – How is ICD-10 going to change what
you do?
ICD-10 Next Steps

Assess & track vendor compatibility

UHS Master Education Plan
◦ Identify all employees and medical staff who need training
by April 15, 2015.
◦ Assign all Precyse Courses in Healthstream by April 30,
2015.
 Be mindful of assigned staff training hours

Dual coding / practicing with ICD-10-CM/PCS
ICD-10 Facility Resources

Cost centers have been established specifically for the resources
needed to implement ICD-10 successfully. This covers both the
training of employees and any necessary back-fill of staff during
training.
◦ ICD -10 Training: coded to account #xxx-86100-687923

Two ICD-10 translation tools:
◦ Code Translation Tool (CTT)

Translates ICD-9 to ICD-10 utilizing description, specific code, code ranges or list of codes.

Training and Roll-out of the CTT tool has been completed and end users are actively using the
tool for Code translation needs.
◦ Financial Impact Tool (FIT)

Analyzes historical DRG data to predict the financial impact of ICD-10, both positive and
negative. Variance reports can be utilized to identify avoidable DRG shifts in order to reduce
financial risk through physician documentation education.

Training and Roll-out of the FIT tool is in progress.
ICD-10 Resources

CMS Resources
◦ MS-DRG Conversion Report
http://www.cms.hhs.gov/ICD10/Downloads/MsdrgConversion.pdf
◦ ICD-10 General Information
http://www.cms.hhs.gov/ICD10

The following organizations offer providers and others ICD10 resources
◦ AHIMA (American Health Information Management Association)
http://www.ahima.org/icd10/default.aspx
◦ WEDI (Workgroup for Electronic Data Interchange)
http://www.wedi.org
◦ HIMSS (Health Information and Management Systems Society)
http://www.himss.org/icd10
QUESTIONS?