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

2. Why Change?

3. 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 ICD-9-CM is over 30 years old Outdated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

4. 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?

5. 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

6. 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.

7. 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.

8. . . 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.
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the first position can be alpha or numeric and the letters used are E or V.
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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

9. 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. >>
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But in ICD-10-CM there can be up to 7 characters.
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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.
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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

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

11. 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

12. 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.

13. 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

14. 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

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

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

17. 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

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

19. Conventions
Code first
Use additional code
Code also
Includes

20. 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

21. 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

22. How to prepare Read Ask questions Talk with others
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23. 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