1. ICD-9-CM ICD-10 Comparison
Created By: Donna, Kristina, Stephanie and Adam

2. ICD-9-CM Established in 1979.
Was created to provide a standard, and uniform code set for diagnoses, and procedures in the United States.
Used for the purpose of payer claims reimbursement, and clinical research.
(Green, 2014)

3. ICD-10-CM Due to be implemented October 14, 2015.
Established to replace the ICD-9-CM in order for more specificity in coding (“Coding to the highest level of specificity”).
Additional digits provide for identifying right, and left, and specific encounter.
(Valerius & Bayes, et. Al., 2014)

4. ICD-9-CM, and ICD-10-CM Diagnostic Code Comparison
3-5 numeric characters in length
Approximately 13,000 codes
Limited space for new codes
Lacks detail
Lacks laterality
3-7 alphanumeric characters in length
Approximately 68,000 codes
Space for additional codes
Very specific
Codes identify right and left
(AMA, 2012)

5. Example of code differences Diagnosis: stage III pressure ulcer of the right lower back.
ICD 9
Two codes are needed for location, and stage, but laterality can not be classified.
Pressure ulcer, lower back
Pressure ulcer stage III
ICD 10
A combination code is used, and laterality is classified.
Pressure ulcer of right lower back, stage III
L89.133
(Green, 2014)

6. Other differences in the ICD-10-CM
The ICD-10 uses a placeholder character “x” to allow for expansion of certain codes.
If a code that requires a 7th character is not 6 characters in length, then the placeholder “x” will take the 6th character place.
Square brackets enclose manifestation codes in the ICD-10 instead of slanted brackets used in the ICD-9.
Boxed notes are not used.
(Green, 2014)

7. Benefits of ICD-10 (why should we convert)
Due to the specificity of ICD-10 there will be greater accuracy, and fewer denials, or underpayments.
The need for additional paperwork sent with claims will be reduced, providing a faster turnaround of claims.
The upgraded classification of the ICD-10 allows room to add additional advancements in medicine.
(HIMSS, 2012)

8. Impact ICD-10 On The Insurance Industry
Will lead to Much greater specificity and clinical information, which results in:
Improved ability to measure health care services;
Increased sensitivity when refining grouping and reimbursement
methodologies;
Enhanced ability to conduct public health surveillance; and
Decreased need to include supporting documentation with claims;
(Boyd, 2014)

9. Impact ICD-10 On The Insurance Industry
Better data for:
Designing payment systems; - system conversion is expensive
Processing claims; less rework so cheaper in the long run
Tracking public health - easier, more specificity
Identifying fraud and abuse - insurance companies will be able to crack down on fraud/abuse
Conducting research. - better more precise date
(Boyd, 2014)

10. Impact ICD-10 On The Insurance Company
Transition to ICD-10 may lead to decreased revenue.
Training staff to understand the new coding system will cost many thousands of dollars.
Transition to ICD-10 may lead to loss of information.
ICD-10 codes would cause the greatest disruption to billing, staffing, inventory selection, practice management, and clinical revenue.
(Boyd, 2014)

11. Impact ICD-10 On the Insurance Company
Assigning ICD-10-CM codes that do not directly map to a code in ICD-9-CM can impact an organization’s reporting and the management of information systems. This is important in regards to the medical records and Insurance companies.
(Boyd, 2014)

12. Two Reasons why the implementation of ICD-10-CM was delayed
Costs to the providers
Allowed health care provider’s and other covered entities the time to prepare and fully test their systems
(McCann, 2012).

13. Costs to the providers (American Medical Association, 2015).
Types of practices
Small
Medium
Large
Payment Disruption
$22,579 - $100,349
$75,26 - $334,498
$752,630 - $3,334,976
Vendor/Software Upgrade
$0 - $60,000
$0 - $200,000
$0 - $2,000,000
Testing
$15,248 - $28,805
$47,906 - $93,098
$428,740 - $880,660
Productivity Loss
$8,500 - $20,250
$72,649 - $166,649
$726,487 - $1,666,487
Assessment
$4,300 - $7,000
$6,535 - $9,600
$19,320
Process Remediation
$3,312 - $6,701
$6,211 - $12,900
$14,874 - $31,821
Training
$2,700 - $3,000
$4,800 - $7,900
$75,100
Total Cost
$56,639 – 226,105
$213,364 - $824,735
$2,017,151 - $8,018,364
(American Medical Association, 2015).

14. Time To Prepare Benefits Improve quality of care
Document medical complications
Categorize diseases
Track healthcare outcomes more effectively
Cost savings due to accuracy of payments and reduction of unpaid claims
Ability to test the system to ensure a smooth transition
(Sanders, et. al., 2012).

15. Time to Prepare Benefits Reduce medical errors
Efficient delivery of services
Improvements in the areas of
Patient safety
Disease Management
Quality Measures
(Sanders, et. al., 2012).

16. Time To Prepare Challenges Financial cost of the transition
$25,000 to $20,000,000 depending on size of facility
Planning and implementation
Shortage of qualified coders
Average age is 54
May opt to retire instead of learning new coding requirements
Need for further training and education of employees
Loss of productivity
(Sanders, et. al., 2012).

17. Approaching ICD-10-CM
We are ultimately responsible for making sure that when we get to a Healthcare facility we have a good understanding of ICD-10-CM. Check it out!!

18. Approaching ICD-10-CM
The high costs risk adjustment of research, training, demonstrations, developing and implementing payment policies. These are expenses that are associated with the new diagnosis system making the cost of accessing it to be way more expensive.

19. Approaching ICD-10-CM
The way we look for the codes will have us better prepared to find ICD-10-CM codes. The codes are going to change but the way we find the codes are going to be the same.

20. References
American Medical Association (2012). The difference between icd9 and icd10. Retrieved from Differences.pdf
American Medical Association (2015). ICD-10 cost estimates increased for most physicians. Retrieved from / icd10- cost-estimates-increased-for-most-physicians.page
Boyd, L. (2014). Study: ICD-10 transition to cause financial, information loss. Journal of tables and charts, 29 (9). Retrieved from Ebscohost.com.
Green, M. (2014) Code it. Clifton Park, NY: Delmar.
Healthcare Information and Management Systems Society (2012). Ten reasons why icd-10 implementation cannot be further delayed. Retrieved from

21. References
McCann, E. (2012). HHS announces one-year delay for ICD-10. Retrieved from: Sanders, T., Bowens, F., Pierce, W., Stasher-Booker, B., Thompson, E., & Jones, W. (2012). The Road to ICD-10-CM/PCS Implementation: Forecasting the Transition for Providers, Payers, and Other Healthcare Organizations. Perspectives in Health Information Management / AHIMA, American Health Information Management Association, 9(Winter), 1f. Retrieved from: Valerius, J., Bayes, N., Newby, C., & Blochowiak, A. (2014). Medical insurance: An integrated claims process approach. New York, NY: McGraw-Hill