ICD-10 Will Be Complex but Useful

Abstract

Joyce Frieden is a senior editor with Elsevier Global Medical News. WASHINGTON — The upcoming ICD-10 diagnosis and procedure coding system is more complicated than ICD-9, but it will allow for greater clinical detail and will reflect advances in technology, according to several speakers at an American Health Information Management Association meeting. “ICD-9 badly needs to be replaced,” said Nelly Leon-Chisen, director of coding and classification at the American Hospital Association. “It's 30 years old, and the terminology and classification of some conditions are obsolete.” There are two parts to ICD-10, formally known as the International Classification of Diseases, 10th revision, which goes into effect in the United States on Oct. 1, 2013: ICD-10-CM, which is the clinical modification of the World Health Organization's ICD-10 diagnostic coding system; and ICD-10-PCS, an inpatient procedural coding system developed under contract to the Centers for Medicare & Medicaid Services. ICD-10 “will have better data for evaluating and improving quality of care. It will provide codes for a more complete picture,” she added, noting that the new code set will allow health officials to be “better able to track and respond to global health threats.” Because ICD-10 can more precisely document diagnoses and procedures, it will bring better justification of medical necessity for billing purposes, “but not from day 1,” said Ms. Leon-Chisen. “It will take a little while” for people to adjust to the new codes. The new system also may reduce opportunities for fraud, she added. Ms. Leon-Chisen outlined a few basic differences between ICD-9 and ICD-10 diagnosis codes: ▸ ICD-9 codes contain 3–5 characters, whereas ICD-10 has 3–7 characters. ▸ In ICD-9 codes, the first character can be alphabetic or numeric, but in ICD-10, the first character is always alphabetic. ▸ ICD-10 codes can include the use of a placeholder “x,” whereas ICD-9 codes cannot. She also gave an example, showing the differences between the two revisions. Under the ICD-9 coding system, a patient with a pressure ulcer on the right buttock might receive a diagnosis code of 707.05, “pressure ulcer, buttock.” Under ICD-10, the same patient would get L89.111, “decubitus ulcer of right buttock limited to breakdown of the skin.” A pressure ulcer on the left buttock or a more severe one including necrosis of the bone would get a different ICD-10 code. Sue Bowman, director of coding policy and compliance for the American Health Information Management Association, noted that ICD-10-PCS can have even more complexities. For example, under ICD-9, there is only one code for artery repair; under ICD-10-PCS, there are 276 codes. However, “once you work with it, you're struck by the logic of the system,” she said. “It's really not that difficult.” Under the ICD-10 code structure, each character has a specific meaning (see box above). Ms. Bowman pointed out some of the differences between procedure codes under the two revisions. For example, ICD-9 procedure codes have 3–4 characters, whereas ICD-10-PCS codes always have 7 characters. Also, all ICD-9 procedure code characters are numeric, whereas ICD-10-PCS code characters can each be alphabetic or numeric; alphabetic characters are not case sensitive. As an example of the difference in procedure codes, she cited the ICD-9 code 17.43 for “percutaneous robotic assisted procedure,” versus 8E093CZ, the ICD-10-PCS code for “robotic assisted procedure of head and neck region, percutaneous approach.” One issue that Medicare officials and others dealing with ICD-10 are wrangling with, Ms. Bowman noted, is when—or whether—both ICD-9 and ICD-10 should be “frozen”—that is, when no more new codes should be added to either code set so that they will be stable while people are making the changeover from ICD-9 to ICD-10. Both code sets are currently updated annually, she said. Sue Bowman of the American Health Information Management Association recommended the following resources for more information on ICD-10: www.cdc.gov/nchs/about/otheract/icd9/abticd10.htm www.cms.hhs.gov/ICD10 www.ahacentraloffice.com/ahacentraloffice_app/ICD-10/ICD-10.jsp www.ahima.org/icd10