ICD-10-CM Changes
Pat Shaw
ICD-10
 ICD-10-CM replaces ICD-9-CM for diagnosis in all
settings
 ICD-10-PCS replaces ICD-9-CM volume 3 procedures
codes for hospital inpatient procedures only
 CPT/HCPCS is not affected
 Implementation discharges/encounters on or after
October 1, 2014.
Coding and 7th Character
Extensions
Alpha
(Except U)
M
A
X
S X
0 X
2
Category
2 Numeric
3 - 7 Numeric or Alpha
.
Additional
Characters
X
6 X
5 X
x
A
X
Etiology, anatomic
site, severity
Added code extensions (7th
character) for obstetrics,
injuries, and external
causes of injury
3 – 7 Characters
3
Coding in ICD-10-CM
ICD-9-CM
ICD-10-CM
Three to five characters
Three to seven characters
First digit is numeric but can be alpha
(E or V)
First character always alpha
2-5 are numeric
All letters used except U
Always at least three digits
Character 2 always numeric: 3-7 can be
alpha or numeric
Decimal placed after the first three
characters (or with E codes, placed
after the first four characters)
Always at least three digits
Alpha characters are not case-sensitive Decimal placed after the first three
characters
4
Alpha characters are not case-sensitive
ICD-10-CM Overview
 Diagnoses
 ICD-9-CM - 14,025
 ICD-10-CM - 68,069
 Procedures
 ICD-9-CM - 3,824
 ICD-10-PCS - 72,589
ICD-10-CM Overview
 Benefits of ICD-10-CM
 ICD-10-CM incorporates much greater clinical detail and
specificity than ICD-9-CM
 Terminology and disease classification have been updated to
be consistent with current clinical practice
 A new modern classification system will provide much better
data needed for:
 Measuring care, quality, safety, and efficacy of care
 Reduction of paper work related to
documentation queries
 Improving payment systems and reimbursement
ICD-10-CM Overview
 New ICD-10-CM features
 Laterality (left, right, bilateral)
 Examples:
 C50.511 - Malignant neoplasm of lower-outer quadrant of
right female breast
 H16.013 - Central corneal ulcer, bilateral
 L89.012 - Pressure ulcer of right
elbow, stage II
ICD-10-CM Overview
 Combination codes for certain conditions and
common associated symptoms and manifestations
 Examples:
 K57.21 - Diverticulitis of large intestine with perforation and
abscess with bleeding
 E11.341 - Type 2 diabetes mellitus with severe
nonproliferative diabetic retinopathy with macular edema
 I25.110 - Atherosclerotic heart
ICD-10-CM Overview
 Combination codes for poisonings and associated
external cause
 Example:
 T42.3X2S - Poisoning by barbiturates, intentional self-harm,
sequela
 Obstetric codes identify trimester instead of episode
of care
 Example:
 O26.02 - Excessive weight gain in pregnancy, second
trimester
ICD-10-CM Overview
 Character “X”
 Used as a 5th character placeholder in to allow for future
expansion and to fill in other empty characters
 Used when a code less than 6 characters in length
requires a 7th character
 Examples:
 T46.1X5A - Adverse effect of calcium-channel blockers,
initial encounter
 T15.02XD - Foreign body in cornea, left eye, subsequent
encounter
ICD-10-CM Overview
 Two types of Excludes notes
 Excludes 1
 Indicates the code excluded should never be used with the
code where the note is located
 Do not report both codes
 Example:
 Q03 - Congenital hydrocephalus
 Excludes 1: Acquired hydrocephalus - G91
ICD-10-CM Overview
 Excludes 2
 Indicates the condition excluded is not part of the condition
represented by the code
 A patient may have both conditions at the same time
 Both codes may be assigned together to capture both
conditions
 Example:
 L27.2 - Dermatitis due to ingested food
 Excludes 2: Dermatitis due to food in contact with skin - L23.6,
L24.6, L25.4
ICD-10-CM Overview
 Inclusion of Clinical Concepts
 Underdosing, blood type, blood alcohol level
 Examples:
 T45.526D - Underdosing of antithrombotic drugs,
subsequent encounter
 Z67.40 - Type O blood, Rh positive
 Y90.6 - Blood alcohol level of 120-199 mg/100 ml
ICD-10-CM Overview
 Code Expansion
 Injuries, diabetes, substance abuse, postoperative
complications
 Examples:
 E10.610 - Type 1 diabetes mellitus with diabetic
neuropathic arthropathy
 F10.182 - Alcohol abuse with alcohol-induced sleep
disorder
 T82.02XA - Displacement of heart valve prosthesis,
initial encounter
ICD-10-CM Overview
 Postoperative complications
 Expanded distinction between intraoperative
complications and postprocedural disorders
 Examples:
 D78.01 - Intraoperative hemorrhage and hematoma of
spleen complicating a procedure on the spleen
 D78.21 - Postprocedural hemorrhage and hematoma of
spleen following a procedure on the spleen
ICD-10-CM Overview
 Other Changes in ICD-10-CM
 Injuries grouped by anatomical site rather than by type
of injury
 Restructuring and reorganization in number of chapters
 Reclassification for certain diseases to different
chapters
 New code definitions
 Definition of acute myocardial
infarction is now 4 weeks rather than
8 weeks
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.
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
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
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
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
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
ICD-10-CM



S52.92xE Fracture, traumatic, radius
S52.202E Fracture, traumatic, ulna
X58.xxxD Index to External Cause, accident
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)
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)
Mapping between Old & New
Systems
ICD-9-CM
GEMs Maps
ICD-9-CM
GEMs Maps
GEMs
ICD-10-PCS
via CMS web site
ICD-10-CM via CMS /NCHS web sites
=
Crosswalks
General equivalence maps (GEMs) between ICD-9-CM and
ICD-10-CM/PCS have been developed
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ICD-10 Resources
 https://www.cms.gov/ICD10/11b14_2012_ICD10CM_and
_GEMs.asp
 2012 Code Set, Official Guidelines, GEMS
 http://www.cms.gov/ICD10