ICD-10-CM Preview Presented by Regina Glenn, PhD., RHIA, CCS Davenport University

Why Change?

Why Change? ICD-9-CM is over 30 years old Outdated Lacking necessary detail to describe conditions and/or procedures performed Not compatible with current medical care Contains obsolete terminology Missing current terminology Results in limited data collection

Why Change? Think about it – How much has health care changed in the past 30 years? How much has the delivery in health care changed in the past 30 years? How can a system that is 30 years old reflect current medical practices?

What is it? ICD-10-CM is a diagnostic classification system that was developed by the CDC for use in the United States. It will replace ICD-9-CM Volumes I and II

Who will use? ICD-10-CM will replace the use of ICD-9-CM to report diseases, injuries, impairments, other health problems, and the causes of those diseases and injuries in ALL healthcare settings.

Who will use? ICD-10-PCS will replace the use of ICD-9-CM to report procedures and treatments on hospital inpatients only. CPT/HCPCS will continue to be use in the outpatient settings to report procedures, treatments and services provided.

. . 5 E V 4 X 1 X 4 X X X How does it look? 3 – 5 Characters Category Numeric or Alpha (E or V) Numeric 5 E V 4 X 1 X 4 X . . X X SLIDE 10:   First, let’s step back and remind ourselves of the structure of ICD-9-CM. It is 3 to 5 digits with a decimal point after the first three. Slide transition  the first position can be alpha or numeric and the letters used are E or V. Slide transition The rest are all numeric only. So a code might look like this one for Arteriosclerotic heart disease (ASHD) It has a hierarchical structure where the first three digits are the category of the code and all codes with the same first 3 digits have common traits. The last two add specificity regarding etiology, anatomic site, or manifestations Category Etiology, anatomic site, manifestation 3 – 5 Characters

Additional Characters How does it look? Additional Characters Alpha (Except U) 2 - 7 Numeric or Alpha . . A X S M X 3 X 2 X 1 X X X A Slide 11   ICD-10-CM has the same hierarchical structure as ICD-9-CM – and all codes with the same first 3 digits have common traits – each digit beyond the first three adds more specificity. It also has the same organization and use of notes and instructions as in ICD-9-CM. <<when a note appears under a 3-character code, it applies to all codes within that category – instructions under a specific code apply to only that single code. >> Slide Transition But in ICD-10-CM there can be up to 7 characters. Slide Transition  The category is to the left of the decimal. There are always at least three characters, and like ICD-9-CM, some codes are only three characters. << An example is code P90, convulsions of newborn, which is a complete code. >> Most three character categories have been subdivided, but some have not. Slide transition Unlike ICD-9 the first character is always alpha and any of the other characters can be alpha or numeric. Up to three characters may follow the decimal, which will further describe the etiology, anatomic site, and/or severity. If the first three characters after the decimal are not enough to describe the condition, an extension may appear in the 7th position. Category Etiology, anatomic site, severity Added code extensions (7th character) for obstetrics, injuries, and external causes of injury 3 – 7 Characters

How does it look? Example: Multiple Sclerosis Current ICD-9-CM 340 ICD-10-CM G35

How does it look? Codes begin with a letter Characters 2 through 7 may be either a letter or a number Uses extensions Provides additional about the condition 7th character May be either a letter or a number Used most often with injury codes

How does it look? Uses placeholders Always the letter “X” Used when the code has less the 6 characters and a 7th character extension is required.

Types of Changes Code groupings More logical grouping of codes based on current medical knowledge Some codes have been reassigned to different chapters Injuries grouped by site instead of type of injury

Types of changes Complete descriptions Complete subcategory titles All characters are listed within the code. Additional characters are no longer located at the beginning of a chapter, section or category

Types of Changes Laterality Specificity Incorporates laterality (right, left, bilateral) into code descriptions Specificity Expanded detail

Types of Changes Combination codes Groups etiology and manifestation ICD-9-CM usually requires two codes Poisonings and external causes

Types of Changes Terminology used Postprocedural Trimester specificity Reflect current medical knowledge Postprocedural Indentifies the difference between postoperative and postprocedural Trimester specificity Pregnancy, delivery and puerperium codes include identification of trimester

Conventions Punctuation Square Brackets Synonyms, alternative wording or explanatory phases Parentheses Nonessential modifiers, optional descriptions

Conventions Code first Use additional code Code also Includes

Conventions Has two excludes notes Excludes 1 means not coded here – the code is excluded and should never be coded at the same time Excludes 2 mean not included here – the code is excluded and can be used at the same time

Coding Clinics Coding Clinics Were designed and written for use with ICD-9-CM Will not longer be valid with ICD-10-CM. New coding clinics will be written for ICD- 10-CM

How to prepare Read Ask questions Talk with others http://www.youtube.com/watch?v=LihXPo6iF xI&feature=related

References: AHIMA (2010) ICD-10-CM Coding Guidelines: An Overview Audio Seminar Barta, A., DeVault, K. & Zeisset, A.. (2010) ICD-10-CM/PCS Academy Coder Training Manual – Instructor’s Edition. AHIMA Press Hazelwood, A. & Venavle, C.A. (2009). ICD-10-CM and ICD-10-PCS Preview. AHIMA Press