1. ICD-9-CM and ICD-10 Updates and U.S. Adoption of ICD-10-CM Coding Standard: Major Changes in Health Information Coding Practice and Implications for Cancer Surveillance Jennifer Ruhl, RHIT, CCS, CTR (NCI SEER) Steve Peace, BS, CTR (Univ. of Miami)

2. Overview  ICD-9-(CM) coding resources  ICD-10 coding resources  Introduction of ICD-10-CM 2

3. ICD-9-(CM) and ICD-10  Uses of medical coding systems for cancer registrars:  Casefinding  Case matching  Record & tumor linkage  Death certificate coding  Follow up and treatment  Special studies 3

4. Updates to ICD-9-CM/ICD-10  ICD-9-CM: Bi-annual updates  Minor update April  Major update October  ICD-10  Scheduled for every three years 4

5. Cancer Registry Sources using ICD-9-CM/ICD-10  ICD-9-CM casefinding list  ICD-9-(CM) to ICD-10  ICD-10 to ICD-9-(CM)  ICD-O-3 to ICD-9-(CM)  ICD-O-3 to ICD-10 5

6. ICD-9-CM Casefinding list  Updated in 2009 and 2010 and includes:  neoplasm codes (malignant, in-situ, benign, borderline)  cancer related diseases  personal history codes  Reviewed by SEER registries  Reviewed by representatives from AJCC CoC and NPCR CDC  Next update due January 1, 2011  http://www.seer.cancer.gov/tools/casefinding/index.html http://www.seer.cancer.gov/tools/casefinding/index.html 6

7. ICD-9-(CM) to ICD-10 and ICD-10 to ICD-9-(CM)  Major update 2009-2010  Incorporated all coding changes since last update (mid 1990s)  Will be posted to SEER website August 2010 7

8. ICD-9-CM to ICD-10 and ICD-10 to ICD-9-CM  Based on 2010 ICD-9-CM Casefinding list  All codes from casefinding list are represented  General Equivalency Mappings (GEMs) used to update  GEMs provided by CMS 8

9. What are the GEMS?  Developed by CMS as a tool to assist with the conversion of ICD-9-CM to ICD-10-CM  Includes:  One to one mapping  One to many mapping 9

10. What are the GEMS, cont.  Intended audiences include:  Coding professionals  Payers/Providers  Medical researcher  Use of GEMS  Converting payment system  Payment and coverage edits  Quality measures 10

11. ICD-9-CM to ICD-10 and ICD-10 to ICD-9-CM  File layout:  Type of Code  Reportable  Supplemental  ICD-9/10 Category Code  ICD-9/10 Term (code description) 11

12. ICD-9-CM to ICD-10 and ICD-10 to ICD-9-CM  Additional reviewers included:  SEER Cancer Registries  Leah Driscoll, CTR (Kentucky)  Frances Ross, BA, CTR (Kentucky)  Westat (Rockville, MD)  Mary Mesnard, BS, RHIA, CTR  Annette Stephens, BA, BS, RHIA  IMS (Silver Spring, MD)  Rashid Aminou, MS  Nicki Schussler, BS 12

13. Our ICD-9-CM/ICD-10 Experts  ICD-9-CM  Amy Blum, MHSA, RHIA, CTR  Medical Systems Specialist, National Center for Health Statistics (NCHS)  ICD-10  Carolyn Watkins  Certified Nosologist  Kenneth D. Kochanek, Statistician  Mortality Statistics Branch, National Center for Health Statistics (NCHS) 13

14. Upcoming projects:  ICD-10 COD Casefinding list  Release date July 2010  ICD-O-3* to ICD-9-(CM)  Scheduled completion: 2011  ICD-O-3* to ICD-10  Scheduled completion: 2011  *Includes new Hematopoietic codes 14

15. ICD-10-CM  U.S. implementation October 1, 2013  Based on ICD-10  Alphanumeric codes  Major changes include:  Laterality coding  New code categories 15

16. ICD-9-CM vs. ICD-10-CM  ICD-9-CM  Numerically based  30 year old coding system  Running out of room for new codes (currently about 11,000 codes)  ICD-10-CM  Alphanumerically based  Less than 20 year old coding system  Ample room for expansion (currently greater than 60,000+ codes) 16

17. ICD-9-CM vs. ICD-10-CM  ICD-9-CM  Limited specificity (only up to 5 digit codes)  Using 30 year old medical terminology  Laterality not included for applicable cancer codes  ICD-10-CM  Greater specificity (up to 7 digit codes)  Updated to current medical terminology  Laterality included for applicable cancer codes  Provides codes for many conditions not included in ICD-9-CM 17

18. Example: Breast, unspecified site  ICD-9-CM code: 174.9  ICD-10 code: C50.9  ICD-10-CM codes:  C50.911: unspecified right female  C50.912: unspecified left female  C50.919: unspecified side female 18

19. Example: Low grade MDS  ICD-9-CM code: 238.72  ICD-10 code: D46.7  ICD-10-CM codes:  D46.a Refractory cytopenia with multilineage dysplasia  D46.b Refractory cytopenia with multilineage dysplasia and ringed sideroblasts 19

20. ICD-10-CM  Preparing the Cancer Registry field  Committee to be formed representing all the Cancer Registry field standard setters  Goal of committee to determine best way to educate cancer registrars about ICD-10-CM 20

21. ICD-10-CM Resources  ICD-10-CM casefinding list  Planned first appearance is January 1, 2013, in conjunction with 2013 ICD-9- CM casefinding list  ICD-9-CM to ICD-10-CM  ICD-10-CM to ICD-10  ICD-O-3 to ICD-10-CM 21

22. ICD-10-PCS  Replacing outdated coding system for procedure codes  Alphanumeric codes  Up to 7 digit long  Codes “developed” through table selection process 22

23. Resources  ICD-10-CM (CMS website)  http://www.cms.gov/ICD10/12_2010_I CD_10_CM.asp http://www.cms.gov/ICD10/12_2010_I CD_10_CM.asp  ICD-10-PCS (CMS website)  http://www.cms.gov/ICD10/13_2010_I CD10PCS.asp#TopOfPage http://www.cms.gov/ICD10/13_2010_I CD10PCS.asp#TopOfPage 23

24. Conclusion  ICD-9-CM and ICD-10 resources published by SEER undergoing major updates  Planning for ICD-10-CM 24