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ICD-10-CM Everything You Need to Know


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Title: ICD-10-CM Everything You Need to Know

ICD-10-CM Everything You Need to Know For Now
Main Objective
  • Create an awareness of ICD-10-CM.
  • Start to consider the impact the conversion to
    ICD-10 will have on your operations.
  • Participants can help spread the word
    throughout the University.

What is ICD-10-CM and When is it Coming?
What is ICD and ICD-10?
  • ICD is the World Health Organization's
    International Classification of Diseases and
    Related Health Problems and is the international
    standard diagnostic classification system.
  • ICD-10 is the abbreviated term used to refer to
    the 10th revision of the ICD.

What is ICD-10-CM and ICD-10-PCS?
  • ICD-10-CM
  • The U.S. clinical modification (CM) of the WHOs
    ICD-10, maintained by the NCHS.
  • Includes diagnoses which will be used by all
    providers in every health care setting.
  • ICD-10-PCS
  • The procedural coding system developed under
    contract by the CMS.
  • Includes procedure codes which will only by used
    for hospitals claims for inpatient hospital

Implementation Date October 1, 2013
  • On January 16, 2009, the Department of Health and
    Human Services published a Final Rule for the
    adoption of ICD-10-CM and ICD-10-PCS code sets.
  • All HIPAA covered entities must be ICD-10
    compliant on October 1, 2013.
  • The compliance date is firm and not subject to
  • There will be no delay.
  • There will be no grace period for implementation.
  • There will be no impact on CPT and HCPCS codes.

ICD-9-CM vs. ICD-10-CM
Why is ICD-9 Being Replaced?
  • ICD-9-CM is out of date and running out of space
    for new codes.
  • Lacks specificity and detail
  • No longer reflects current medical practice
  • ICD-10 is the international standard to report
    and monitor diseases and mortality, making it
    important for the U.S. to adopt ICD-10 based
    classifications for reporting and surveillance.
  • ICD codes are the core elements of HIT systems,
    conversion to ICD-10 is necessary to fully
    realize benefits of HIT adoption.

Coding Process Remains the Same
  • ICD-10-CM code book retains the same traditional
  • Index
  • Tabular
  • Process of coding is similar
  • Look up a condition in the Index
  • Confirm the code in the Tabular

Major Differences Between ICD-9-CM and ICD-10-CM
13,600 codes 69,000 codes
Code book contains 17 chapters Code book contains 21 chapters
Consists of 3 to 5 characters Consists of 3 to 7 characters
1st character is alpha or numeric 1st character is alpha
Only utilizes letters E and V Utilizes all letters (except U)
Second, third, fourth, and fifth characters are always numeric Second character is always numeric
Third, fourth, fifth, sixth, and seventh characters can be alpha or numeric
Shorter code descriptions because of lack of specificity and abbreviated code titles Longer code descriptions because of greater clinical detail and specificity and full code titles
Comparison of ICD-9-CM and ICD-10-CM
  • ICD-9-CM Code
  • Icd-10-CM code
  • A - Category of code
  • B - Etiology, anatomical site, and manifestation
  • A - Category of code
  • B - Etiology, anatomical site, and/or severity
  • C - Extension
  • 7th character for obstetrics, injuries, and
    external causes of injury

Comparison of ICD-9-CM and ICD-10-CM
ICD-9-CM Codes ICD-10-CM Codes
Pressure ulcer codes 9 codes 707.00 707.09 Pressure ulcer codes 125 codes L89.0-L89.94
Codes 707.0 Pressure ulcer 707.00 -
unspecified site 707.01 - elbow
707.02 - upper back
707.03 - lower back 707.04 - hip
707.05 - buttock 707.06
- ankle 707.07 - heel
707.09 - other site
Code Examples L89.131 Pressure ulcer of right
lower back, stage I L89.132 Pressure ulcer of
right lower back, stage II L89.133 Pressure
ulcer of right lower back, stage III L89.134
Pressure ulcer of right lower back, stage
IV L89.139 Pressure ulcer of right lower back,
unspecified stage L89.141 Pressure ulcer of
left lower back, stage I L89.142 Pressure ulcer
of left lower back, stage II L89.143 Pressure
ulcer of left lower back, stage III L89.144
Pressure ulcer of left lower back, stage
IV L89.149 Pressure ulcer of left lower back,
unspecified stage L89.151 Pressure ulcer of
sacral region, stage I L89.152 Pressure ulcer
of sacral region, stage II L89.90 Pressure
ulcer of unspecified site, unspecified stage
New Features of ICD-10-CM
  • Combination codes for conditions and common
    symptoms or manifestations
  • Combination codes for poisonings and external
  • Added laterality
  • Expanded codes injury, diabetes,
    alcohol/substance abuse, postoperative

New Features of ICD-10-CM
  • Added extensions for episode of care
  • Inclusion of trimester in obstetrics codes and
    elimination of fifth digits for episode of care
  • Expanded detail relevant to ambulatory and
    managed care encounters
  • Inclusion of clinical concepts that do not exist
    in ICD-9-CM
  • Changes in timeframes specified in certain codes

Examples ICD-10-CM Codes
  • I10, Essential (primary) hypertension
  • A69.21, Meningitis due to Lyme Disease
  • O9A.311, Physical abuse complicating pregnancy,
    first trimester
  • S52.131A, Displaced fracture of neck of right
    radius, initial encounter for closed fracture

Examples - Combination Codes
  • Combination codes for conditions and common
    associated symptoms and manifestations
  • I25.110, Arteriosclerotic heart disease of native
    coronary artery with unstable angina pectoris
  • K50.013, Crohns disease of small intestine with
  • Combination codes for poisonings and their
    associated external cause
  • T42.3X2S, Poisoning by barbiturates, intentional
    self harm, sequela

Examples Combination Codes
Diabetes Codes in ICD-9 Diabetes Codes in ICD-10
249.70 - Secondary diabetes mellitus with peripheral circulatory disorders, not stated as uncontrolled 785.4 - Diabetic gangrene 443.81 - Diabetic peripheral angiopathy E09.52 - Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene
250.31 - Diabetes with other coma, type I, not stated as uncontrolled E10.11 - Type 1 diabetes mellitus with ketoacidosis with coma
250.60 - Diabetes with neurological manifestations, type II or unspecified, not stated as uncontrolled 355.9 - Mononeuritis of unspecified site E11.41 - Type 2 diabetes mellitus with diabetic mononeuropathy
249.40 - Secondary diabetes mellitus with renal manifestations , not stated as uncontrolled 585.9 - Chronic kidney disease, unspecified E08.22 - Diabetes mellitus due to an underlying condition with diabetic chronic kidney disease
Examples Added Laterality
  • C50.212, Malignant neoplasm of upper-inner
    quadrant of left female breast
  • H16.013, Central corneal ulcer, bilateral
  • L89.213, Pressure ulcer of right hip, stage III
  • H61.20, Impacted cerumen, unspecified, ear
  • H61.21, Impacted cerumen, right ear
  • H61.22, Impacted cerumen, left ear
  • H61.23, Impacted cerumen, bilateral

Examples Obstetrics and New Clinical Concepts
  • Obstetric codes identify trimester instead of
    episode of care
  • O26.02, Excessive weight gain in pregnancy,
    second trimester
  • Inclusion of clinical concepts that do not exist
    in ICD-9-CM
  • T45.526D, Underdosing of antithrombotic drugs,
    subsequent encounter
  • Z67.40, Type O blood, Rh positive

New Official Guidelines and Coding Clinic
  • The AHA Central Office serves as the
    clearinghouse for issues related to the use of
  • With the transfer to ICD-10, a new office will be
    developed called AHA Central Office on ICD-10-CM
  • Creation of new official guidelines
  • Development of the AHA Coding Clinic for ICD-10
    (similar to the Coding Clinic for ICD-9 but will
    require a major overhaul)

General Equivalence Mappings
What are GEMs?
  • GEMs stands for General Equivalence Mappings
  • The CMS and the CDC created GEMs to ensure
    consistent national data when the U.S. adopts
  • The GEMs will act as a translation dictionary to
    bridge the language gap between the two code
    sets and can be used to map an ICD-9 code to an
    ICD-10 code and vice versa.

Purpose of GEMs
  • Designed to give all sectors of the healthcare
    industry that use coded data the tools to
  • Convert large databases and test system
  • Link data in long-term clinical studies
  • Develop application-specific mappings
  • Analyze data collected before and after the
    transition to ICD-10-CM

Not a Substitute for Coding
  • The GEMs should not be used as a substitute for
    learning how to use the ICD-10-CM code sets.
  • GEMs are not a substitute for learning
    ICD-10-PCS and ICD-10-CM coding. Theyll help
    you convert large data sets.
  • Mapping simply links concepts in the two code
    sets, without consideration of context of
    specific patient information, whereas coding
    involves assigning the most appropriate code
    based on documentation and applicable coding

Why a GEM Wont Always Work
  • A clear one-to-one correspondence between an
    ICD-9 or ICD-10 code is the exception rather than
    the rule.
  • ICD-9 codes 414.01 Coronary atherosclerosis of
    native coronary artery and 411.1 Intermediate
    coronary syndrome (unstable angina)
  • ICD-10 code I25.110 Atherosclerotic heart
    disease of native coronary artery with unstable
  • There are situations when a code in the target
    system does not exist
  • T503x6A Underdosing of electrolytic, caloric and
    water-balance agents, initial encounter

Forward and Backward Mapping
Forward Mapping
ICD-9 Code Description (Source)
820.8 Fracture of unspecified part of neck of femur, closed
Backward Mapping
ICD-9 Code Description (Target)
820.8 Fracture of unspecified part of neck of femur, closed
Preparing for ICD-10
ICD-10 Implementation Plan
Checklist http//www.ahima.org/icd10/ICD-10Prepar
2009/ 2010
Awareness and Impact Assessment
Phase I
Preparing for Implementation
Phase II
Go Live Preparation
Phase III
Post Implementation
Phase IV
ICD-10-CM Preparation
  • Create awareness among faculty and staff.
  • Identify your current systems and work processes,
    whether electronic or manual, in which you use
  • Identify potential changes to existing practice
    workflow and business processes.

ICD-10-CM Preparation
  • Assess status of business associates and vendors
    ICD-10 readiness.
  • Budget for implementation costs.
  • Conduct a detailed assessment of education needs.

Assessment of Educational Needs
  • Identify who will require education
  • Coding professionals
  • Providers
  • Billing personnel
  • Clinical personnel
  • Administrative staff and Management
  • Researchers
  • Determine what type and level of education they
    will need.
  • Assess the current level of coder education and
  • Assess the level of knowledge necessary per
    person/role based on job responsibilities.
  • Determine the best method of education.

Coder Training and Education
  • Build awareness to understand the impact of the
    code set change and the differences between the
    code sets
  • Develop pre-requisite skills where needed, for
    example, in the biomedical sciences
  • Educate on the foundational concepts on the
    structure and organization of the code sets
  • Role-based application just in time
  • 3 9 months prior to implementation

Coder Training and Education
  • The DHHS recommends inpatient/hospital coders
    receive 50 hours of training and outpatient
    coders receive 10 hours of training.
  • AHA/AHIMA anticipates that a maximum of 16 hours
    of training may be sufficient for experienced
    coding professionals on ICD-10-CM only.
  • 6 hours learning the fundamentals (structure,
    coding conventions, guidelines and how ICD-10 is
  • 6 hours in more intensive training applying the
    conventions and guidelines
  • 4 hours practicing applying codes to typical

Education Requirements - AHIMA
  • AHIMA Certified Professionals are required to
    participate in a predetermined number of
    mandatory baseline educational experiences
    specific to ICD-10-CM.
  • RHIT 6 CEUs
  • RHIA 6 CEUs
  • CCS-P 12 CEUs
  • CCS 18 CEUs
  • CCA 18 CEUs

Proficiency Test - AAPC
  • AAPC members holding a credential will have two
    years to pass a proficiency test
  • You will be given two (2) years to pass the exam,
    beginning October 1, 2012 (one year before
    implementation of ICD-10) and ending September
    30, 2014 (one year after implementation)
  • The test will consist of 75 questions
  • The test will be open-book, online and
  • Coders will be allowed two (2) attempts to pass
    for the 60 administration fee

Clinical Documentation
  • The increased specificity of the ICD-10 codes
    requires more detailed clinical documentation in
    order to code some diagnoses to the highest level
    of specificity.
  • There are unspecified codes in ICD-10-CM for
    those instances when medical record documentation
    is not available to support more specific codes.
  • The benefits of ICD-10 can not be realized if
    non-specific codes are used rather than taking
    advantage of the specificity ICD-10 offers.

Improving Documentation
  • Conduct medical record documentation assessments
  • Evaluate records to determine adequacy of
    documentation to support the required level of
    detail in new coding systems
  • Implement a documentation improvement program to
    address deficiencies identified during the review
  • Educate providers about documentation
    requirements for the new coding system through
    specific examples
  • Emphasize the value of more concise data capture
    for optimal results and better data quality

Physician Training
  • DHHS agrees that some physicians will want
    intensive training on ICD-10 but some will seek
    awareness training.
  • Nolan study estimates 8 hours of intensive
    physician training
  • Nachimson Advisors, LLC study predicts 12 hours
    of physician training in both the code set and
    documentation procedures.
  • AHIMA believes most physicians would want no more
    than 4 hours of training.

Fee Tickets
  • AHIMA/AHA study found the process of converting
    fee tickets to ICD-10-CM is not difficult, time
    consuming, or expensive. Most can be converted
    to ICD-10 in just a few hours and they are no
    longer in length than existing fee tickets.
  • Making the fee ticket more manageable
  • Electronic fee ticket
  • Hybrid coding
  • Context-specific fee tickets
  • Limit specificity/code options
  • List 7th character separate

Coder Proficiency
  • AHA/AHIMA field test demonstrated that people
    with previous ICD-9-CM experience can learn
    ICD-10-CM easily.
  • Proficiency in use of the system will be
    dependent on a number of factors, including level
    of coder education and experience.
  • It is anticipated that most coders will have a
    high level of proficiency within 6 months of use.

ICD-10 Web Resources
  • 2010 versions of ICD-10-CM, GEMs and the Official
    Guidelines are all available on-line.
  • CMS, AHA, AHIMA and NCHS/CDC all have ICD-10
    resource centers.
  • AHIMA has a free monthly ICD-10 Newsletter
  • http//www.ahima.org/images/newsletters/ICDTen/sub

  • While it is too early to start learning how to
    code utilizing the ICD-10-CM code set, it is
    never to early to start planning/preparing for
    the transition.
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