© 2014 Healthcare Code Sets, Clinical Terminologies, and Classification Systems Chapter 1: International Classification of Diseases (ICD) and the U.S. Modifications

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Modification of World Health Organization (WHO) ICD-9 Used in the U.S. to code and classify diagnoses for all submitting claims ICD-9-CM volume 3 used to code inpatient procedures

Developer The WHO developed ICD 9 th revision in 1979 National Center for Health Statistics o Clinical Modification o Council on Clinical Classification o Modified for U.S. hospitals Classification for morbidity 5 th -digit subclassifications Procedures

Purpose Originally – statistics and research Currently – also reimbursement

Uses Classify morbidity and mortality for statistical purposes Index hospital records Report diagnoses and procedures for reimbursement Store and retrieve data Determine patterns of care among providers Analyze payments for health services Perform epidemiological and clinical research Measure quality, safety, and efficacy of care Design payment systems Set health policy Monitor resource utilization Implement operational and strategic plans Design healthcare delivery systems Improve clinical, financial, and administrative performance Prevent and detect healthcare fraud and abuse Track public health and risks

International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) Revision began in 1983 Volume 1 (Tabular List) published in 1992 Volume 2 (Instruction Manual) published in 1993 Volume 3 (Alphabetic Index) published in 1994

Adoption Most countries have adopted United States uses only for mortality statistics Clinical modifications in use o Australia (ICD-10-AM) o Canada (ICD-10-CA) U.S. modifications o ICD-10-CM

Developer Collaborative product o WHO (copyright) o 10 international centers Increased categories from previous revisions via an alphanumeric coding scheme

Purpose Multinational collection o Mortality and morbidity data o Systematic Recording Analysis Interpretation Comparison

Content General Structure o Epidemic diseases o Constitutional or general diseases o Local diseases, arranged by site o Development diseases o Injuries Structural Components o Volumes (1, 2, and 3) o Chapters (21) o Codes Alphanumeric (1 st character is a letter) Up to 5 characters (XXX.XX)

New Features Exclusion notes Blocks Notes Drug-induced conditions Postprocedural disorders Complete titles Etiology and manifestation

Conventions Instructional Terms and Notes o Inclusion and exclusion terms o Includes notes and exclusion notes o Use additional code Punctuation Marks o Parentheses o Square brackets o Colons o Braces o Dash Abbreviations o NEC o NOS Relational Terms o And o With, with mention of, associated with, in o Without, not associated with o Due to, resulting in Dagger (etiology) and Asterisk (manifestation) Lead terms Modifiers or qualifiers Cross-references

Principles and Guidelines Located in fourth section of volume 2, Instructional Manual Adopted by WHO to provide guidance o Underlying cause of death o Main/secondary conditions analysis for morbidity data Must follow guidelines for WHO reporting of mortality data

Process for Revision and Updates Collaborating Centres for Classification of Disease o Updating and Revision Committee Morbidity Reference Group Mortality Reference Group Proposals must be sponsored (NCHS in the US) Submit proposals based on a time line If modification accepted, both WHO and Centres distribute

U.S. Modification ICD-10-CM ICD-10-PCS Implementation scheduled for October 1, 2015 Developed by NCHS and CMS

ICD-10-CM Return to ICD-9-CM level of specificity Develop an improved alphabetic index Modify code titles for consistency with US medical practice Remove codes unique to mortality coding or those designated specifically for emerging nations Remove procedure descriptions included with diagnosis codes Expand specificity for ambulatory and managed care encounters Expand to include new concepts Expand to include emerging diseases and more recent medical knowledge

Uses ICD-10-CM replaces ICD-9-CM Volumes 1 and 2 Report diseases and conditions of patients treated in the US healthcare system

Content Changes from ICD-9 V and E codes incorporated into main classification New diseases are classified Injuries are grouped by body part Excludes notes expanded Additional combination codes Laterality added Postoperative complications expanded Obstetric codes indicate trimester, but not delivery status Information relevant to ambulatory and managed care encounters added Greater specificity allowed

Similarities to ICD-9-CM Maintained by NCHS Same hierarchical structure Same organization and use of notes and instructions Same conventions and guidelines

Differences from ICD-9-CM Overall organization and structure Code composition Level of detail

Structural Changes Format o XXX.XXX X o Category Etiology, anatomic site o Extension Seventh characters add specificity

Organizational Changes V codes and E codes incorporated Sense organs separated from nervous system disorders Injuries grouped by body part Order of some chapters rearranged Immune system categories expanded Excludes notes expanded Chapter blocks provide structural overview Postoperative complications incorporated into procedure-specific body system chapters

New Features Creation of combination codes Addition of laterality, predominantly in neoplasm and injury chapters Expansion of surgical complications and distinction made between intra- and post-operative Expansion of alcohol/drug abuse codes Expansion of injury codes Addition of combination codes for poisoning and external causes Greater specificity

New features, cont. Elimination of OB episode of care; addition of trimester Elimination of controlled versus uncontrolled in the classification of diabetes Significant revisions: Mental and Behavioral Disorders; Injury, Poisoning and Certain Other Consequences of External Causes; External Causes of Morbidity and Mortality Elimination of “malignant” versus “benign” in the classification of hypertension Time frames in some codes have changed Elimination of episodes of care in the acute myocardial infarction subdivisions

Excludes Notes Two types o Excludes 1 o Excludes 2

Content Three to seven characters o Three characters to left of decimal point (called category) o Up to four additional characters to the right (provide etiology, anatomic site or severity of condition) First character always alpha character All letters used except U

Alphabetic Index Two major sections o Index to Diseases and Injuries o Index to External Causes Neoplasm Table Table of Drugs and Chemicals Use of dash

Tabular List Twenty-one chapters Codes listed in order Sections Categories Subcategories Subclassification Codes must be assigned to highest level of specificity

Conventions Placeholder character Seventh characters Abbreviations o NEC o NOS Punctuation o Brackets o Parentheses o Colons

Conventions Includes notes Excludes notes o Excludes1 o Excludes2 Etiology/manifestation convention Cross-reference terms o AndSee o WithSee also o Code also note

Locating a Code Locate term in Alphabetic index Verify code in Tabular List Follow all notes and cross-references\ Code to the highest level of specificity including laterality

General Guidelines Signs and symptoms Multiple coding Acute and chronic conditions Combination codes Sequela Impending or threatened condition Reporting same diagnosis code more than once

General Guidelines Laterality Documentation for BMI, ulcers Syndromes Complications of care Borderline diagnosis

Principles, Guidelines, and Updates Official guidelines on NCHS website ICD-10-CM contains no procedures Revision and updates to remain similar to ICD- 9-CM

ICD-10-PCS 1990s – pilot project for preliminary design Funded by CMS (formerly HCFA) 1995 awarded contract to 3M HIS Replaces ICD-9-CM, Volume 3 Significant increase in specificity

Essential Characteristics Completeness Expandability Multi-axial Standard terminology

Content Seven-character, alphanumeric O and I not used (to eliminate confusion with zero (0) and one (1), which are used) First character specifies the section (16) Three separate parts o Tables o Index o List of Codes

Meaning of Characters: Medical and Surgical Procedures SectionBody System Root Operation Body Part ApproachDeviceQualifier

Content ICD-10-PCS Tables ICD-10-PCS Index Body Part Key Device Key Device Aggregation Table

Principals and Guidelines Diagnostic information is not included in procedure description “Not otherwise specified” (NOS) options are restricted Limited use of “not elsewhere classified” (NEC) option Level of specificity Conventions

Process for Revision and Update Updated every year Once implemented revision procedures expected to remain similar to ICD-9-CM