ICD-10

Q: What is ICD-10 CM/PCS?

A: ICD-10 CM/PCS is believed to be the biggest data change ever for the healthcare industry. It replaces the current ICD-9 classification system and affects payers, providers, and vendors. ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision), is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. It is divided into two parts, ICD-10 CM and ICD-10 PCS.  ICD-10 CM is used to assign diagnosis codes. ICD-10 PCS is used to assign procedure codes. Beginning October 1, 2014, ICD-10 CM will be used by all providers to assign diagnoses codes to patient visits. ICD-10 PCS will be used only for hospital claims to assign procedure codes to inpatient procedures.

Q: Why does healthcare need the ICD-10 classification system?

A: The current classification system, ICD-9 CM, was developed 30 years ago. Since that time there have been advances in technology and the discovery of additional diseases. ICD-9 is no longer expandable and is unable to accurately describe diagnoses to the level of detail needed for the management of the healthcare system in the 21st century. Because of these shortcomings ICD-10 CM/PCS will be adopted in the United States on October 1, 2014. A number of countries have already adopted ICD-10 CM/PCS. If the United States does not join these countries, the statistics reported for diagnosis codes will be flawed due to the lack of compatible data to compare internationally. The use of an outdated classification system could potentially impact the identification and tracking of new health threats (e.g., SARS, anthrax). Adoption of ICD-10 CM/PCS will aid in the tracking of quality measures, public health surveillance, research, organizational monitoring, health information technology, and reimbursement.

Q: What is the difference between ICD-9 and ICD-10?

A: The implementation of ICD-10 CM/PCS signals an upgrade in the country’s current classification system. There are approximately 17,000 codes available for use with ICD-9 CM. The adoption of ICD-10 CM/PCS will make more than 155,000 codes available and will aid in the implementation of new codes as the evolution of medical technology and medical procedures continues. In effect, ICD-10 is more detailed than ICD-9.

ICD-9 CM (Diagnosis Codes) ICD-10 CM (Diagnosis   Codes)
Consists of 3-5 digits Consists of 3-7 characters
First digit is alpha or numeric (E or V) First character is always alpha
Second-fifth digits are numeric Second character is numeric
Limited space for adding new codes Flexibility for adding new codes
Decimal placed after the first 3 digits Decimal placed after the third character
Alpha characters are not case sensitive Characters 3-7 can be alpha or numeric
17,000 codes Approximately 68,000 codes

 

ICD -9 CM Volume 3 (Procedure   Codes) ICD-10 PCS (Procedure  Codes)
ICD-9-CM has 3-4 digits.  A   decimal is placed after the 2nd digit. ICD-10 PCS has 7 characters and no decimals
All digits are numeric Each character can be alpha or numeric
Numbers 0-9; letters A-H, J-N, P-Z.    The letters I and O are not used to avoid confusion with one and zero.
All codes must have at least 3 digits Each code must have 7 characters
Generic body parts Detailed descriptions of body parts
3,000 codes 87,000 codes

 

 

Q: ICD Systems Example List

A:

ICD-10
Examples of Systems and Applications That May Use Coded Data
Encoding software Case mix systems
Medical record abstracting systems Managed care reporting systems
Billing systems Case management systems
DRG groupers Disease management systems
Electronic health record systems Financial systems
Clinical systems Provider profiling systems
Decision support systems Test ordering systems
Computer-assisted coding applications Clinical reminder systems
Registration and scheduling Performance measure systems
Utilization management Medical necessity software
Quality management Aggregate data reporting systems
Computerized Physician Order Entry (CPOE) systems Registries
Clinical protocols Compliance software
Fraud management systems Patient assessment data sets (e.g., MDS, PAI, OASIS)

 

Q: ICD-10 Data Users

ICD-10 CM/PCS
Examples of Categories of Data Users Requiring ICD-10 Education
Coders Clinical department managers
Other HIM professionals Ancillary departments
Clinicians Data analysts
Senior management Researchers
Information technology Epidemiologists
Quality management Performance improvement
Utilization management Corporate compliance
Accounting Data quality management
Business office Data security
Auditors and consultants Clinical documentation improvement (CDI) specialists
Patient access and registration Payer contract managers and negotiators
Other data users Registry personnel