1. ICD-10-CM

2. History of ICD-9
World Health Organization (WHO) developed ICD-9 for use worldwide
U.S. developed clinical modification (ICD-9-CM)
-Implemented in 1979 in U.S.
-Expanded number of diagnosis codes
-Developed procedure coding system

3. Why is ICD-9 Being Replaced?
Out of date and running out of space for new codes.
Approx. 30 years old –technology has changed
Many categories full
Lacks specificity and detail
No longer reflects current medical practice

4. Why We Need a New Coding System?
Reimbursement–would enhance accurate payment for services rendered
Quality–would facilitate evaluation of medical processes and outcomes

5. Characteristics Needed in a Coding System
Flexible enough to quickly incorporate emerging diagnoses and procedures
Exact enough to identify diagnoses and procedures precisely
ICD-9-CM is neither flexible nor exact.

6. Reimbursement and Quality Problems With ICD-9-CM
Example –fracture of wrist
-Patient fractures left wrist
-A month later, fractures right wrist
ICD-9-CM does not identify left versus right–requires additional documentation
ICD-10-CM describes
-Left versus right
-Initial encounter, subsequent encounter
-Routine healing, delayed healing, nonunion, or malunion

7. Reimbursement and Quality Problems With ICD-9-CM
Example –combination defibrillator pacemaker device
Codes for this device are not in the cardiovascular chapter of ICD-9 CM with other defibrillator and pacemaker devices
Coders and researchers have trouble finding these codes with this type of erratic code assignment
ICD-10-PCS provides distinct codes for all these types of devices, in an orderly manner that is easy to find

8. Benefits of Adopting the New Coding System
Incorporates greater specificity and clinical information and results in:
–Improved ability to measure health care services
–Increased sensitivity when refining grouping and reimbursement methodologies
–Enhanced ability to conduct public health surveillance
–Decreased denials and decreased need to include supporting documentation with claims

9. Coding Process Remains the Same
ICD-10-CM code book retains the same traditional format
-Index
-Tabular
Process of coding is similar
-Look up a condition in the Index
-Confirm the code in the Tabular

10. ICD-10, a brief History
1990 –Endorsed by World Health Assembly (diagnosis only)
1994 –Release of full ICD-10 by WHO
2002 –ICD-10 published in 42 languages
Implementation:
–138 countries for mortality
–99 countries for morbidity
1999 –U.S. implemented for mortality (death certificates)

11. Countries Using ICD-10 For Reimbursement
United Kingdom (1995)
Denmark, Finland, Iceland, Norway, Sweden (1994 –1997)
France (1997)
Australia (1998)
Belgium (1999)
Germany (2000)
Canada (2001)

12. ICD-10-CM Major Modifications
Added trimesters to obstetrical codes (5th digits from ICD-9-CM will not be used)
Revised diabetes mellitus codes (5th digits from ICD-9-CM will not be used)
Expanded codes (e.g., injury, diabetes)
Added code extensions for injuries and external causes of injuries

13. Laterality –Left Versus Right
C50.1 -Malignant neoplasm, of central portion of breast
C Malignant neoplasm of central portion of right female breast
C Malignant neoplasm of central portion of left female breast

14. Differences Between ICD-9-CM and ICD-10-CM
Approx. 14,000 codes
69,000 codes
17 chapters
22 chapters
3 to 5 characters
3 to 7 characters
1st character is alpha or numeric
1st character is alpha
2nd, 3rd, 4th, and 5th characters are always numeric
2nd character is always numeric but 3rd through 7th characters can be alpha or numeric
Shorter code descriptions because of lack of specificity and abbreviated code titles
Longer code descriptions because of greater clinical detail and specificity and full code titles

15. Comparison of ICD-9-CM and ICD-10-CM
ICD-9-CM CODE
ICD-10-CM CODE
A - Category of code
B - Etiology, anatomical site, and manifestation
A - Category of code
B - Etiology, anatomical site, and/or severity
C - Extension
7th character for obstetrics, injuries, and external causes of injury A B A B C

16. ICD-9-CM Code Structure
Numeric or Alpha
(E or V)
Numeric X V 5 E 4 1 X 4 X . X X
Category
Etiology, Anatomic
Site, Manifestation
3 – 5 Characters

17. ICD-10-CM Structure – Format
Alpha
(Except U)
Additional Characters
2 - 7 Numeric or Alpha . . X M A S 3 X 2 X X 1 X X A X
Category
Etiology, Anatomic
Site, Severity
Added code extensions (7th character) for obstetrics, injuries, and external causes of injury
3 – 7 Characters

18. Comparison of ICD-9-CM and ICD-10-CM
ICD-9-CM Codes
ICD-10-CM Codes
Pressure ulcer codes -9 codes
Pressure ulcer codes -125 codes
Codes:
707.0 Pressure ulcer
unspecified site
elbow
upper back
lower back
hip
buttock
ankle
heel
other site
Code Examples:
L – Pressure ulcer of right lower back, stage I
L – Pressure ulcer of right lower back, stage II
L – Pressure ulcer of right lower back, stage III
L – Pressure ulcer of right lower back, stage IV
L – Pressure ulcer of right lower back, unspecified stage
L – Pressure ulcer of left lower back, stage I
L – Pressure ulcer of left lower back, stage II
L – Pressure ulcer of left lower back, stage III
L – Pressure ulcer of left lower back, stage IV
L – Pressure ulcer of left lower back, unspecified stage
L – Pressure ulcer of sacral region, stage I
L – Pressure ulcer of sacral region, stage II
L89.90 – Pressure ulcer of unspecified site, unspecified stage
The codes on the right are only a small set of the 125 potential pressure ulcer codes offered in ICD-10
Pressure ulcer stages 707.2x separate codes (6 codes) , difficult to match up if more than one pressure ulcer

19. Full Code Titles ICD-9-CM 143 Malignant neoplasm of gum 143.0Upper gum
143.1Lower gum
ICD-10-CM
C03 Malignant neoplasm of gum
C03.0 Malignant neoplasm of upper gum
C03.1 Malignant neoplasm of lower gum

20. Arrangement of Volumes of ICD-10
Volume 3: Alphabetical Index
Volume 1: Tabular list
Volume 2: Instruction manual
-ICD-9 has 17 chapters
-ICD-10 has 22 chapters

21. END of Part-1