Diagnostic Coding: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)

2


Diagnostic Coding


International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)



Objectives


After completing this chapter, readers should be able to:


image Have a rudimentary understanding of the new coding system ICD-10-CM.


image Apply the basic steps studied in Chapter 1 for application with the new coding system.


image Be able to identify and code correct diagnosis based on documented specificity.


image Recognize and use the tables in the ICD-10-CM Index.


image Understand the differences between ICD-9 and ICD-10 coding systems.


image Correctly enter ICD-10-CM codes on a claim form.


KEY TERMS


















































Term Definition
Manifestation code A display or characteristic signs or symptoms of an illness. Also known as an asterisk (∗) code in some editions of ICD-10.
CDC Centers for Disease Control.
Classification Standard grouping of diseases by a set of principles.
CM Clinical modification.
CMS Centers for Medicare and Medicaid Services.
Default code A code located in the Index that refers to a condition most commonly associated with the main term. An unspecified code where a higher level of specificity is not presented.
ICD-10-CM International Classification of Disease, Tenth Edition, Clinical Modification.
ICD-10-PCS International Classification of Disease, Tenth Edition, Procedural Coding System.
NEC Not elsewhere classified: A category of codes to be used only when the coder lacks the information required to code the term to a more specific category.
Place holder Usually a fifth digit character that is an “x” that must be used for correct code selection.
Sequela Morbid condition following as a consequence of a disease.
Specificity Applying the highest level of code based on the documentation of patient care.
Underlying cause Typically a patient’s main condition. In some editions of ICD-10 these codes are also referred to as a dagger (†) code.
WHO World Health Organization.

This chapter is designed to introduce the reader to the new ICD-10-CM coding system that is scheduled for implementation on October 01, 2013 as the only diagnosis coding system used by the United States.


The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was passed to set standards for electronic health care transactions. The ICD-10-CM is part of the HIPAA regulations for electric claims processing and transmitting.


Although diagnosis coding (ICD) is not easy, it is essential to good reporting of services provided to enhance reimbursements received. As stated in the previous chapter on ICD-9-CM, it is easier to locate codes when you have a good working knowledge of medical terminology, basic anatomy and physiology, and a fundamental understanding of the ICD-9-CM and ICD-10-CM coding conventions and applications.



History


Traditionally, the World Health Organization (WHO) revises ICD code books once every 10 years. The newest version (ICD-10) was originally released in 1992. The United States did not adopt the new code set because offices were in a learning process for correct usage of ICD-9-CM coding. Additionally, our computer systems were not equipped to accept the new coding format because we had just created the format for fourth- and fifth-digit coding required by ICD-9-CM. Additionally, there were concerns regarding changes for specific use in the United States for the Clinical Modifications required to meet our needs and standards.


According to government officials, the new coding system (ICD-10-CM) will go into effect as of October 01, 2013. At that time, only the 10th edition will be the accepted system to report a diagnosis. The government is currently working to complete the translation and revision of ICD-10-CM and to upgrade computer software to accommodate the new format.




For Comparison and Communication


Agreeing on the definitions of groups at a regional, national, and international level enables comparison of results and merging of information from different sources.


Each individual case is assigned to exactly one category (group). The categories do not overlap (i.e., they are mutually exclusive), and there is a category for every case.


The International Classification of Diseases is designed to serve as a way to capture mortality and morbidity data for reporting for public health, epidemiology, and treatment, and allows comparison of frequencies—for example causes of death from the community level up to the whole world.


ICD is the international standard for this purpose, with all WHO member states having committed to report causes of death and illness to WHO since 1967 (nomenclature regulations). The ICD (International Statistical Classification of Diseases and Related Health Problems) is a classification that is used in 194 countries. It has been developed internationally since 1891. ICD coding has had 10 major revisions with the most recent changes being ICD-10.


The United States has set an implementation date of October 1, 2013, for the new diagnosis code system, ICD-10-CM, to go into effect. coding professionals should start familiarizing themselves with the classification system to prepare for its future use.



What is ICD-10-CM?


ICD-10-CM is a clinical modification of the World Health Organization’s ICD-10, which consists of a diagnostic system. ICD-10-CM includes the level of detail needed for morbidity classification and diagnostic specificity. It also provides code titles and language that complement accepted clinical practice. As with ICD-9-CM, ICD-10-CM is maintained by the National Center for Health Statistics.


The system consists of more than 68,000 codes, compared to approximately 13,000 ICD-9-CM codes. ICD-10-CM codes have the potential to reveal more about quality of care, so that data can be used in a more meaningful way to better understand complications, better design clinically robust algorithms, and better track the outcomes of care. ICD-10-CM incorporates greater specificity and clinical detail to provide information for clinical decision making and outcomes research.














Code structure of ICD-10-CM versus ICD-9-CM
ICD-10-CM codes may consist of up to seven digits, with the seventh-digit extensions representing visit encounters or sequelae for injuries and external causes.
ICD-9-CM Code Format ICD-10-CM Code Format
image image


image



ICD-10-CM Structure


ICD-10-CM has an index and tabular list similar to those of ICD-9-CM. However, the ICD-10-CM index is much longer. As with ICD-9-CM, ICD-10-CM uses an indented format for both the index and tabular list. Categories, subcategories, and codes are contained in the tabular list.


Coding professionals will need to:


Monitor the National Center for Health Statistics web site (http://www.cdc.gov/nchs) for any new versions of the guidelines, index, and tabular list before implementation.


As with ICD-9-CM, proper coding relies on use of the guidelines, which house all information about the coding conventions for ICD-10-CM, general use guidelines, and chapter-specific guidelines for the tabular list. Coding guidelines are also in the index.


The two parts of the ICD-10-CM index are the index to diseases and injury and index to external causes of injury. The table of drugs and chemicals and the neoplasm table are housed in the index to diseases and injury.


The former V codes are now Z codes contained in Chapter 21, “Factors Influencing Health Status and Contact with Health Services.”







Excludes 2


A type 2 Excludes note represents “NOT INCLUDED HERE.” An Excludes2 note indicates that the condition excluded is not part of the condition it is excluded from but a patient may have both conditions at the same time. When an Excludes2 note appears under a code it is acceptable to use both the code and the excluded code together. For example, J04.0, Acute laryngitis has an Excludes2 of chronic laryngitis (J37.0).


There are three volumes that comprise ICD-10:



Let’s take a look at each one in detail.


Volume 1, the Tabular List, is an alphanumeric listing of diseases, disease groups, and health-related problems. It contains inclusion and exclusion notes and some coding rules.



EXAMPLE



In Volume 2, the Alphabetical Index, is an alphabetical list of the diseases and conditions that have codes in the Tabular List.


image

There are more entries in the Index than there are in the Tabular List because some diseases have more than one name and some diseases are grouped under one code. Not all of the names that appear for a code will be found in the Tabular listing. Always trust the index to guide you to the most appropriate code in the Tabular List.


Volume 2, Alphabetical Index also contains:




EXAMPLE






Coding System Objectives


The new classification system provides significant improvements though greater detailed information and the ability to expand in order to capture additional advancements in clinical medicine. The ICD-10 coding system is divided into two parts.










ICD-10-CM The diagnosis classification system developed by the Centers for Disease Control and Prevention for use in all U.S. health care treatment settings. Diagnosis coding under this system uses three to seven alphabetical and numerical digits and full code titles. The format or layout of the codes is much the same as ICD-9-CM.
ICD-10-PCS The procedure classification system developed by the Centers for Medicare & Medicaid Services (CMS) for use in the United States for inpatient hospital settings and hospital billing only. This coding system uses seven alphabetical or numerical digits unlike the three or four numerical digits used in the ICD-9-CM system.


Why the Need for Change?


The current system, ICD-9-CM:



The following examples are provided to illustrate the completeness and preciseness of ICD-10-CM code selections versus ICD-9-CM coding selections.



EXAMPLE



























Pressure ulcer codes of the lower back
ICD-9-CM (nine location codes)
Show broad location—not depth or stage		 ICD-10-CM (125 codes)
More specific location with depth & stage
707.03 Pressure ulcer lower back L89.131∗ Pressure ulcer of right lower back, stage I
    L89.132∗ Right lower back, stage II
    L89.144∗ Left lower back, stage IV


image

























































































































ICD-9-CM VS ICD-10-CM CHAPTER COMPARISONS
  ICD-9-CM ICD-10-CM  
Chapter I 001-139 A00-B99 Certain Infectious and Parasitic Diseases
Chapter II 140-239 C00-D49 Neoplasms
Chapter III 240-279
(Endocrine)		 D50-D89 Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism
Chapter IV 280-289
(Blood)		 E00-E89 Endocrine, Nutritional, and Metabolic Diseases
Chapter V 290-319 F01-F99 Mental and Behavioral Disorders
Chapter VI 320-389 G00-G99 Diseases of the Nervous System
Chapter VII 390-459
(Circulatory)		 H00-H59 Diseases of the Eye and Adnexa
Chapter VIII 460-519
(Respiratory)		 H60-H95 Diseases of the Ear and Mastoid Process
Chapter IX 520-579
(Digestive)		 I000-I99 Diseases of the Circulatory System
Chapter X 580-629
Genitourinary		 J00-J99 Diseases of the Respiratory System
Chapter XI 630-677
(Pregnancy)		 K00-K94 Diseases of the Digestive system
Chapter XII 680-709
(Skin)		 L00-L99 Diseases of the Skin and Subcutaneous Tissue
Chapter XIII 710-739
(Musculoskeletal)		 M00-M99 Diseases of the Musculoskeletal System and Connective Tissue
Chapter XIV 740-759
(Congenital)		 N00-N99 Diseases of the Genitourinary System
Chapter XV 760-779
(Perinatal)		 O00-O99 Pregnancy, Childbirth, and the Puerperium Period
Chapter XVI 780-799
(Signs)		 P00-P96 Certain Conditions Originating in the Perinatal Period
Chapter XVII 800-999
(Injury)		 Q00-Q99 Congenital Malformations
Chapter XVIII V01-V89
V-Codes
(Health Status)		 R00-R99 Symptoms, Signs, and Abnormal Clinical and Laboratory Findings Not Elsewhere Classified
Chapter XIX E000-E999
E-Codes
(External Causes)		 S00-T88 Injury, Poisoning, and Certain Other Consequences of External Causes
Chapter XX   V00-Y99 External Causes of Morbidity
(Originally E Codes)
Chapter XXI   Z00-Z99 Factors Influencing Health Status and Contact with Health Services
(Originally V Codes)

Related posts:

  1. Putting it All Together
  2. Accounts Receivable
  3. Insurance Claim Forms
  4. Service and Procedural Coding: Current Procedural Terminology (CPT)

Stay updated, free articles. Join our Telegram channel
Tags:
Dec 10, 2016 | Posted by in GENERAL SURGERY | Comments Off on Diagnostic Coding: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)

Full access? Get Clinical Tree
Get Clinical Tree app for offline access