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The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification Office of the Center Director,

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Presentation on theme: "The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification Office of the Center Director,"— Presentation transcript:

1 The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification Office of the Center Director, Data Policy and Standards National Center for Health Statistics Donna Pickett, MPH, RRA CDC Centers for Disease Control and Prevention nchs

2 ICD-10 Evaluation Contract Assess whether ICD-10 significant improvement over ICD-9-CM to warrant implementation for morbidity reporting Recommend additional improvements to ICD-10 and to correct any problems identified during the course of evaluation. Develop a revised alphabetic index and a crosswalk to ICD-9-CM

3 Contract Findings ICD-10 not significantly better than ICD-9-CM for morbidity applications to warrant implementation. A clinical modification of the ICD-10 would be a significant improvement and worth implementing.

4 Why a Clinical Modification ? Need to: –remove codes unique to mortality coding –remove procedure codes included with diagnosis codes –remove “multiple” codes (e.g., S69.7, multiple injuries of wrist & hand) –combine the dagger and asterisk codes

5 Phase II Creating the Clinical Modification Further evaluation of ICD-10 categories to provide codes for ambulatory and managed care encounters, clinical decision-making and outcomes research Evaluation of residual categories (“Other Specified”) to determine whether further specificity is needed

6 Phase II Focused Reviews Review of previous Coordination and Maintenance Committee recommendations that could not be incorporated into ICD-9-CM due to space limitations Consultation with physician groups and others to assure clinical accuracy

7 ICD-10-CM Major Modifications Addition of sixth character Incorporation of common 4th and 5th digit subclassification Addition of Laterality Combining dagger/asterisk codes

8 ICD-10-CM Major Modifications continued Created combination diagnosis / symptoms codes Deactivated procedure codes Further expansion of post-operative complication codes

9 Injury codes in ICD-9-CM/ICD-10 Open wounds –laceration w/foreign body –laceration w/o foreign body –puncture wound w/foreign body –puncture wound w/o foreign body –bite Superficial wounds –abrasion –blister –contusion –external constriction –superficial foreign body –insect bite

10 ICD-10-CM Expanded Injury Codes Detail for open wounds added at 5th digit S41.01 Laceration of shoulder without foreign body S41.02 Laceration of shoulder with foreign body S41.03 Puncture wound of shoulder without foreignbody

11 Injury Codes Expanded Injury Codes S00.411 Abrasion of ear, right ear S50.351 Superficial foreign body of right elbow S81.012 Laceration without foreign body, left knee

12 ICD-10-CM Expanded Injury Codes Laterality added at 6th digit S41.011 Laceration of shoulder without foreign body, right shoulder S41.022 Laceration of shoulder with foreign body, left shoulder S41.032 Puncture wound of shoulder without foreignbody, left shoulder

13 Injury codes in ICD-10-CM Confirmed abuse T74.02 Child neglect or abandonment T74.12 Child physical abuse T74.22 Child sexual abuse T74.32 Child psychological abuse Suspected abuse T76.02 Child neglect or abandonment, suspected T76.12 Child physical abuse, suspected T76.22 Child sexual abuse, suspected T76.32 Child psychological abuse, suspected

14 Poisonings T39.0 Poisoning by salicylates T39.00 Poisoning by salicylates, undetermined intent T39.01 Poisoning by salicylates, accidental (unintentional) T39.02 Poisoning by salicylates, intentional self-harm T30.03 Poisoning by salicylates, assault

15 Poisonings Carbon Monoxide T58.0 Toxic effect of carbon monoxide from motor vehicle exhaust T58.00 Toxic effect of carbon monoxide from motor vehicle exhaust, undetermined intent T58.01 Toxic effect of carbon monoxide from motor vehicle exhaust, accidental (unintentional) T58.02 Toxic effect of carbon monoxide from motor vehicle exhaust, intentional self-harm T58.03 Toxic effect of carbon monoxide from motor vehicle exhaust, assault

16 Poisonings Carbon Monoxide- cont’d T58.1x Toxic effect of carbon monoxide from utility gas T58.2x Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels T58.8x Toxic effect of carbon monoxide from other source T58.9x Toxic effect of carbon monoxide from unspecified source.

17 ICD-10-CM Expanded External Cause Codes Y07.11 Biological father as perpetrator of maltreatment and neglect Y07.13 Adoptive mother as perpetrator of maltreatment and neglect Y07.410 Brother as perpetrator of maltreatment and neglect Y07.420Foster father as perpetrator

18 Place of Occurrence Y92.0xx Non-institutional (private) residence Y92xx Institutional (non-private) residence Y92.2xxSchool, other institution Y92.3xxSports and athletics area Y92.4xxStreet and highway Y92.5xxTrade and service area Y92.6xIndustrial and construction area Y92.7xFarm Y92.8xxOther specified place

19 Place of Occurrence Examples Y92.0 Non-institutional (private) residence Y92.01 Single-family non-institutional (private) house Y92.010 Kitchen Y92.012 Bathroom Y92.016 Swimming pool

20 Activity Y93.0xx Injured while engaged in sports activity Y93.1xx Injured while engaged in leisure activity Y93.4 Injured while resting, sleeping, eating or engaging in other vital activities Y93.8 Injured while engaged in personal hygiene Y93.9 Injured during unspecified activity

21 Activity Examples Y93.0 Injured while engaged in sports activity Y93.01x Individual school sports activity Y93.02x Non-school sports activity Y93.03x Individual military sports activity Y93.04x School group sports activity Y93.05x Non-school sports activity Y93.06 Military group sports activity

22 ICD-10-CM Expanded Injury /External Cause Codes Extensions added to Injury and External Cause chapters Ainitial encounter for treatment of injury Bsubsequent encounter for treatment of injury

23 ICD-10-CM Next Steps Complete review of contractor's report and recommendations Finalize Tabular List revisions Revise Index & Crosswalks  Revise guidelines  Develop training materials  Testing  Comparability study  Additional tools: database version

24 ICD-10-CM Testing CDACs: 3,000 medical records NCHS contractor: several hospitals (inpatient and outpatient) Other testing: AHA, AHIMA and others will also test

25 HIPAA and ICD-10-CM Implementation Implementation of ICD-10-CM is tied to the standards adoption process specified in the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

26 HIPAA and ICD-10-CM Implementation The Administrative Simplification (AS) provisions of HIPAA are intended to reduce the costs and administrative burdens of health care by making possible the standardized, electronic transmission of many administrative and financial transactions that are currently carried out manually on paper.

27 Administrative Simplification Provisions of HIPAA Outlines national framework for: –Electronic data interchange –Health data standards –Health Information privacy –Improving efficiency and effectiveness of health care system

28 New Code sets Under HIPAA No decisions have been made regarding new code sets NPRM advised those who produce and process data to anticipate changes and build in system flexibility to allow implementation of different formats Any recommendation for new standards requires public hearings & new NPRM

29 Web Sites NCHS Classification of Diseases: Information about ICD-9-CM and ICD-10-CM http://www.cdc.gov/nchs/icd9.htm Administrative Simplification Frequently Asked Questions http://aspe.os.dhhs.gov/admnsimp/

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