ICD-10 vs. ICD-9

UPDATE: As ICD-10, after delay after delay, is finally looming in the near future, we're updating some previous posts with vital information about this new system and what you need to do before the deadline for ICD-10 compliance.

Last week's post, Introducing ICD-10, was a very short introduction to the new ICD-10 code system that will be required in 2014 2015. Since the transition from ICD-9 to ICD-10 is major and requires multiple steps, it will be hard to put such a massive amount of information into one post. So, for the next few weeks, we are going to be dedicating posts solely to informing you of all aspects of ICD-10.

In our entry last week, we outlined tips for designing an ICD-10 implementation plan. Please know that this is something only you can set up with your practice. We cannot create a plan for you! However, Client Services will be happy to serve as a reference if and when you have a question. This and future posts are also meant as references to help with the process of designing and executing your plan.

Now that you have been introduced to ICD-10, this week we will cover:

• The history of ICD-10
• The benefits of ICD-10
• The major differences between ICD-9 and ICD-10 coding

According to the ICD-10 Official Guidelines for Coding and Reporting, "the ICD-10-CM is a morbidity classification published by the United States for classifying diagnoses and reason for visits in all health care settings." Originally adopted in 1990 by the World Health Assembly (WHO), the official compliance date for transferring to ICD-10 diagnosis codes will be on October 1, 2014 October 1, 2015. The compliance date was initially set for October 1, 2013, but has been delayed to next year and then delayed yet again! With 2014 fall 2015 fast approaching, it is time to start preparing for the transition.

A good start is to know how the ICD codes have changed from version 9 to 10. ICD-10 diagnosis codes have been designed to enhance the world of medical coding in several ways. According to ICD-10 trainer DeLinda Ross's presentation, ICD-10-CM At A Glance, ICD-10 codes "provide more clinical detail and specificity", promote a better quality of coding and documentation, and "provide better data for research quality measurements, and setting health policy". Already, ICD-10 sounds like a vast improvement to ICD-9, right? With more specificity and less margin of error, doctors will be able to better communicate between each other for the benefit of the patient.

These benefits manifest themselves in the changes to ICD-10 coding. These changes include:

• The addition of two characters: Whereas ICD-9 codes contain 3 to 5 character per code, ICD-10 codes contain 3 to 7 characters.
• Example: XXX.XXXX = 7 character code
• Note: all codes must be at least 3 digits and a decimal separates the 3rd and 4th characters.
• The placeholder x : for codes using the 7th character, but not the 5th or 6th characters, x can be used to mark the character's place in the code without giving it a value. 
• Example: T75.4xxA = electrocution, shock from electric current, shock from electroshock gun (taser), initial encounter
• 7th character defines encounter: 
• Initial encounter
• Subsequent encounter
• Sequela
• Combination codes: include conditions, symptoms, and/or manifestations. These are defined by parenteses or brackets.
• Example: T360x1D = poisoning by penicillins, accidental (unintentional), subsequent encounter
• Laterality: pinpoint which side of the body has the condition
• Example: left hand, right shoulder, left ear, right lung, etc.
• Timeframes: removing the 5th digit in a code indicates episode of care/trimester for OB codes
• Example: O99.013 = anemia complicating pregnancy, third trimester

The ICD Codebook has experienced some changes as well. Whereas the ICD-9 codebook had 17 chapters, the codebook for ICD-10 diganosis codes now has 21 chapters. Many of those chapters have been reorganized. For instance, eyes and ears now have their own chapters rather than being grouped with the nervous system. In addition, "chapters are organised by body or organ system or by etiology or nature of the disease process" (Ross). From there, each chapter is then divided into subchapters. 

Note: The list of changes to ICD-10 diagnosis codes goes on, but cannot be covered in a short blog post. The ICD-10 Official Guidelines for Coding and Reporting contains the complete list of changes.

More information about ICD-10 is sure to follow, so keep an eye out for next week's post on Testing.

Questions? Concerns? We'd love to help! Just let Client Services know via the Feedback button. Also, if you know of any resources to help others, please leave a comment below.

Researched and compiled by: Kylie McKenzie Soder