Thursday, January 17, 2013

ICD-10 – A Guide to Understanding the Upcoming Medical Coding Language

Since its implementation in 1979, ICD-9-CM has been the most important code set in the world of medical billing and coding. On October 1, 2013, all of that will change. This date represents the implementation of ICD-10 by the U.S. Department of Health and Human Services (HHS). With a new code set comes radically new ways of coding health care procedures and diagnoses, and if you plan to work as a medical biller or coder after that date, it is best that you prepare for the change.

Fortunately, organizations such as the American Association of Professional Coders (AAPC) have already started to roll out online and in-person ICD-10 implementation training programs, and a wealth of free information regarding this daunting development in medical billing and coding is now available. By informing yourself now, you can be completely prepared for ICD-10 when it comes. This knowledge will also greatly enhance your appeal to employers, and can help you to keep your current position if you’re already working as a medical biller or coder.

ICD-10 vs. ICD-10-CM vs. ICD-10-PCS

As you browse the Internet looking for resources devoted to ICD-10, you’ll probably come across a few different names for this code set – ICD-10, ICD-10-CM, ICD-10-PCS – and wonder whether they’re all referring to the same thing. In the U.S., and within this guide, the term "ICD-10" actually refers to ICD-10-CM. This is ICD-10′s "clinical modification," and it’s what most U.S. websites are referring to when they simply state "ICD-10."

ICD-10-PCS is a separate designation, meaning "procedural coding system." ICD-10-PCS effectively replaces the third volume of ICD-9-CM and contains 71,000 codes of its own, separate from the 69,000 included in ICD-10-CM. It was developed by 3M Health Information Management (HIM) in cooperation with the Centers for Medicare and Medicaid. Meanwhile, ICD-10-CM was developed by the World Health Organization (WHO), an entity that’s entirely separate from 3M HIM.

ICD-10-CM refers to outpatient services, such as diagnoses provided in physicians’ offices, while ICD-10-PCS refers to inpatient services, such as hospital stays, beds, nursing services, and surgical procedures.

In short, and from here on out in this guide:
ICD-10 = ICD-10-CM = Outpatient
ICD-10-PCS = Inpatient

ICD-10 at a Glance
ICD-10, when expanded, means the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems
ICD-10 includes codes for diseases, complaints, abnormal findings, signs, and symptoms, external causes of diseases and injuries, and social circumstances, all of which are classified by WHO, or the World Health Organization.
ICD-10 comprises over 69,000 codes (or 140,000 codes, when including those found in ICD-10-PCS), whereas ICD-9-CM only contains 13,600 codes.
ICD-10 offers codes for new diagnoses developed since the implementation of ICD-9.

Why ICD-10?

ICD-9-CM is out of date. Since its implementation, new diseases and diagnoses have been discovered, and the current system of three-digit categories with no more than 10 subcategories each simply can’t cover all of the reasons why people seek medical treatment anymore.

The extra level of detail available with ICD-10 will streamline the process of submitting claims, and will make initial claims significantly easier to understand from the perspective of the one paying. The new system will also make it easier to track and analyze disease patterns and the outcomes of treatments, allowing for faster and bigger advancements in medical care.

Another reason for implementing ICD-10 is because the U.S. is behind. ICD-10 was first introduced by the WHO in 1993, and, according to, many countries, including France, the United Kingdom, and Germany, have been using ICD-10 for years. The U.S. will finally join them.

How is ICD-10 Different From ICD-9-CM?

You might be inclined to panic when you realize that ICD-10 contains approximately five times as many codes as ICD-9. However, there’s no need for alarm. The reason why ICD-10 contains so many additional codes is simple – specificity. ICD-10 allows you to use a single code to report both a disease and the current manifestation of that disease. This same system applies to injuries. For example, ICD-10 includes separate codes for an initial bone fracture, a follow-up appointment showing the fracture healing normally, a follow-up appointment showing the fracture in nonunion, and a follow-up appointment showing the later effects of the fracture.

The composition of the codes themselves are different as well. ICD-9 codes can be three to five digits long, and are mostly numeric, though V and E codes are alphanumeric. All ICD-10 codes will be alphanumeric. Each code will start with a letter, followed by a number, followed by a combination of letters and numbers. Codes may range in length from three to seven digits.

What Does ICD-10 Mean for Those with Current Certifications?

For now, and even when ICD-10 is implemented in the fall of 2013, ICD-10 will not affect the validity of current certifications. However, from one year before until one year after ICD-10′s implementation, those with credentials, such as CPC, CPC-H, and CPC-P, can take an online, open-book ICD-10 proficiency examination. The exam will consist of 75 questions, and coders will be allowed to attempt passing it twice for a fee of $60, according to the AACP.

How Will My Work Change After ICD-10 is Implemented?

The ways in which your job will change will largely depend on the type of setting in which you currently work. The most important changes are noted for each department commonly found in a healthcare facility:

If you’re in a coding department…
You’ll need to learn the new coding system, which includes roughly 55,000 codes with which you may not be familiar.
You’ll need to learn the new code books and styles, which are receiving complete overhauls.
You’ll need to use both ICD-10 and ICD-9 simultaneously for a period of roughly two years.
You’ll need to work with your office’s physician to go over the new documentation requirements.
You’ll need to have a thorough understanding of medical terminology and human anatomy, due to the increased specificity of ICD-10.

If you’re in a billing department…
You’ll need to be trained in a new set of policies and procedures, which could result in lowered productivity if your employer doesn’t start training soon enough, or worse, doesn’t provide any ICD-10 training at all.
You’ll need to learn the new policies regarding payment reimbursement.
You’ll need to understand the new electronic formatting procedures, in addition to the new ANSCI reporting methods.

Comparing ICD-9-CM Codes to ICD-10 Codes

Although ICD-9-CM codes can be messy and confusing, the codes included in ICD-10 have their complications as well. Let’s compare the two to break down the differences.

ICD-9-CM codes…
Contain three to five digits.
Start with either E, V, or a number.
Consist of only numbers with the possible exception of the first digit.
Begin with a category and end with a subcategory, anatomic area, and/or severity.

For ICD-10 codes…
Codes range in length from three to seven digits.
The first digit is always a letter.
The second digit is always a number.
The remaining digits can be any mix of letters and numbers.
In a seven-digit code, for example, the first three digits indicate the category, the second three digits indicate a subcategory, anatomic site, and/or severity, and the final digit represents an extension.

For example, an ICD-10 code might indicate the following:
First three digits: Category.
Fourth digit: Etiology.
Fifth digit: Location.
Sixth digit: Laterality.
Seventh digit: Extension.

Mapping ICD-9-CM Codes to ICD-10 Codes

Since both ICD-9-CM and ICD-10 codes will be used concurrently in the immediate aftermath of ICD-10 implementation, you’ll need to have an understanding of how to map the old codes to the new ones. Some codes will map directly — although this doesn’t necessarily represent a detailed match — while others will require you to seek additional information in order to arrive at a solution.

For example, code 649.51 is used in ICD-9-CM to indicate spotting that’s complicating a pregnancy. In this case, ICD-10 requires you to know and note the current duration of the woman’s pregnancy. The following examples show the proper codes in accordance with this information and illustrate how the increased specificity of ICD-10 doesn’t actually add much complexity to the responsibilities of a coder:
First Trimester – Spotting Complicating Pregnancy: O26.851
Second Trimester – Spotting Complicating Pregnancy: O26.852
Third Trimester – Spotting Complicating Pregnancy: O26.853

Of course, some mapping tasks are far more complex. Fortunately, the AAPC offers a conversion mapping reference sheet, complete with color coding and pneumonic tips, that should give you a head start toward understanding how to convert ICD-9-CM codes to ICD-10 ones.

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