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ICD-10 FAQ

FAQ 1.  What is ICD-10-CM?

ICD-10-CM is the long awaited diagnosis code set revision to ICD-9-CM.  There is another code set known as ICD-10-PCS (Procedure Coding System).  ICD-10-PCS will be discussed in FAQ 6 below.

The International Classification of Diseases (ICD) is the copyrighted official publication of the World Health Organization (WHO). The primary purpose of ICD is for epidemiological tracking of illness and injury. ICD has been used in the US since 1949 (ICD­6). The first formal US adaption was by the US Public Health Service with ICD­7. The current US adaptions are controlled by the “cooperating parties”: National Center for Health Statistics/CDC (NCHS), Centers for Medicare and Medicaid Services (CMS), American Hospital Association (AHA), and American Health Information Management Association (AHIMA).

FAQ 2.  What is the implementation date for ICD-10?

The scheduled compliance date for implementation of the ICD-10-CM/PCS Coding System has been delayed until not before October 1, 2015 for all covered entities.

FAQ 3.  Why do we need ICD-10-CM?

Frankly, ICD-9-CM is running out of codes. Hundreds of new diagnosis codes are submitted by medical societies, quality monitoring organizations and others annually. ICD-10-CM will allow not only for more codes but also for greater specificity and thus better epidemiological tracking. This will allow providers to better identify certain patients with specific conditions that will benefit from tailored disease management programs, e.g. diabetes, hypertension, asthma.

FAQ 4.  How are ICD-9 and ICD-10 different?

The ICD-10-CM codes are very different from those currently used in ICD-9-CM. All codes in ICD-10-CM are alpha-numeric. There may be up to seven alpha-numeric characters, requiring billing software program changes to accommodate the additional digits, as well as extensive coder training. ICD-10-CM will have greater specificity (i.e. granularity) along with laterality (anatomic location). Specialty societies had significant input in the development of the depth of detail they wanted to enable the tracking of certain conditions and injuries.  Given the increased level of coding specificity required by ICD-10, it is anticipated the degree of documentation required by physicians will also increase.

ICD-10-CM codes will be able to provide more in depth information about the patient's condition that can be more easily captured in an electronic medical record. Physician (HCFA 1500) and hospital (UB-04) billing forms have been updated to accommodate the changes.

Examples:

ICD-9-CM

ICD-10-CM

Precordial Chest Pain

786.51

R07.2

Asthma, Acute Exacerbation

493.92

J45.901

Thumb laceration

Thumb, w/o nail damage, initial encounter

883.0

S61.011A

Laceration w/o FB, right thumb, initial encounter, OR

S61.012A

Laceration w/o FB, left thumb, initial encounter, OR

S61.019A

Laceration w/o FB, unspecified thumb, initial encounter

*Just as with ICD-9-CM, clear physician documentation will be important to aid in assigning appropriate ICD-10-CM codes.

FAQ 5.  What is GEM?

General Equivalence Mappings (GEM) were developed by NCHS and CMS, with collaboration of AHIMA and AHA, as a tool to assist with the conversion from ICD-9-CM codes to ICD-10-CM and the conversion of ICD-10-CM codes back to ICD-9-CM. The GEMs are forward and backward mappings between the ICD-9-CM and ICD-10-CM coding systems and are used to help develop crosswalks that provide important information linking codes of one system with codes in the other.

In some instances, there is not a translation between an ICD-9-CM code and an ICD-10-CM code. When there is no plausible translation from a code in one system to a code in the other system, a "No Map" flag indicator is noted.

FAQ 6.  What is ICD-10-PCS?

ICD-10-PCS (Procedure Coding System) is currently designated to replace Volume 3 of ICD-9-CM for hospital inpatient use. PCS is ONLY for hospital use at this time. CMS has stated ICD-10-PCS is not intended to replace CPT.

CPT remains the procedure coding standard for physicians, regardless of whether the physician services were provided in the inpatient or outpatient setting. Any third party payer asking for Volume 3 procedure codes to be submitted along with CPT codes for outpatient services is in violation of HIPAA regulations and subject to fines by CMS.

Some preliminary inpatient hospital testing of ICD-10-PCS has indicated that the new procedure coding system is problematic to learn for both experienced and inexperienced coders.

FAQ 7.  What are the estimated costs for adopting the new ICD-10 coding systems?

There have been many questions as to the cost of implementing ICD-10. The RAND Science and Technology Policy Institute is publishing its findings on the cost and benefits of implementing ICD-10. According to the draft executive summary, providers will incur costs for computer reprogramming, the training of coders, physicians, and code users, and for the initial and long-term loss of productivity among coders and physicians. The cost of sequential conversion (10-CM then 10-PCS) is estimated to run $425M to $1.15B in one-time costs plus somewhere between $5 and $40 million a year in lost productivity.

RAND assumes the benefits as largely coming from the additional detail that ICD-10-CM and ICD-10-PCS would offer. The benefit of more accurate payments to hospitals for new procedures ranges from $100M to $1.2B. Benefits from fewer rejected claims would be $200M to $2.5B and $100M to $1B for fewer exaggerated claims. The identification of more cost-effective services and direction of care to specific populations would result in a benefit of $100M to $1.5B. This is in addition to any benefits that would come from better total disease management and better directed preventive care.

Blue Cross and Blue Shield sponsored a study to determine costs to the health care industry in adopting ICD-10-CM and ICD-10-PCS. The study indicated a cost range of $5.5-13.5 billion for systems implementation, training, loss of productivity, re-work, and contract re-negotiations during a 2-3 year implementation period. Over half of the costs would be borne by health care providers. Long term recurring costs for loss of productivity were estimated at $150 million to $380 million. However, both hospitals and third party payers have already made extensive investments in preparation for the October 1, 2014 scheduled change over. 

FAQ 8.  How is ICD-10 organized?

The ICD-10-CM code set contains an alphabetic Index to Diseases and Injuries, a Neoplasm Table, a Table of Drugs and Chemicals, Index to External Causes, and 21 chapters in the Tabular List of Diseases and Injuries.  The table below provides ICD-10-CM tabular chapter subjects and corresponding alpha numeric code ranges.

            Chapter

Alpha Numeric

  1. Certain Infectious and Parasitic Diseases

A00-B99

  1. Neoplasms

C00-D49

  1. Blood and Blood-forming Organs

D50-D89

  1. Endocrine, Nutritional and Metabolic Diseases

E00-E89

  1. Mental, Behavioral, and Neurodevelopmental Disorders

F01-F99

  1. Nervous System

G00-G99

  1. Eye and Adnexa

H00-H59

  1. Ear and Mastoid Process

H60-H95

  1. Circulatory System

I00-I99

  1. Respiratory System

J00-J99

  1. Digestive System

K00-K95

  1. Skin and Subcutaneous Tissue

L00-L99

  1. Musculoskeletal System and Connective Tissue

M00-M99

  1. Genitourinary System

N00-N99

  1. Pregnancy, Childbirth and the Puerperium

O00-O9A

  1. Certain Conditions Originating in the Perinatal Period

P00-P96

  1. Congenital Malformations, Deformations and Chromosomal Abnormalities

Q00-Q99

  1. Symptoms, Signs and Abnormal Clinical and Laboratory Findings

R00-R99

  1. Injury, Poisoning and Certain Other Consequences of External Causes

S00-T88

  1. External Causes of Morbidity

V00-Y99

  1. Factors Influencing Health Status and Contact with Health Services

Z00-Z99

FAQ 9.  Where can I learn more about ICD-10-CM and ICD-10-PCS?

The following list provides examples of ICD-9-CM codes frequently used in Emergency Medicine, and approximate ICD-10-CM equivalents:

ICD-9-CM

ICD-10-CM Description

276.51

Dehydration

305.00

Alcohol abuse with unspecified alcohol-induced disorder

311

Major depressive disorder, single episode, unspecified

300.00

Anxiety disorder, unspecified

345.90

Epilepsy, unspecified, not intractable, without status epilepticus

346.90

Migraine, unspecified, not intractable, without status migrainosus

372.30

Conjunctivitis, unspecified

382.9

Otitis media, unspecified, right ear

401.9

Hypertension NOS

410.71

Non-ST elevation (NSTEMI) myocardial infarction

427.31

Atrial fibrillation, unspecified

435.9

Transient cerebral ischemic attack, unspecified

462

Acute pharyngitis, unspecified

465.9

Acute upper respiratory infection, unspecified

486

Pneumonia, unspecified organism

491.21

Chronic obstructive pulmonary disease with (acute) exacerbation

493.92

Asthma, unspecified with (acute) exacerbation

558.9

Noninfective gastroenteritis and colitis, unspecified

682.6

Cellulitis of left lower limb

719.46

Pain in right knee

724.2

Low back pain

729.5

Pain in left upper arm

729.5

Pain in right forearm

729.5

Pain in left thigh

729.5

Pain in right lower leg

592.0

Calculus of kidney

599.0

Urinary tract infection, site not specified

646.63/599.0

Unspecified infection of urinary tract in pregnancy, second trimester

785.1

Palpitations

786.2

Cough

786.05

Shortness of breath

786.52

Chest pain on breathing

786.59

Chest pain, Other

786.50

Chest pain, unspecified

789.06

Epigastric pain

789.09

Abdominal pain, upper, unspecified

789.09

Abdominal pain, lower, unspecified

787.01

Nausea with vomiting, unspecified

787.91

Diarrhea, unspecified

780.4

Dizziness and giddiness

780.60

Fever, unspecified

784.0

Headache

780.79

Malaise, other

780.79

Fatigue, other

780.2

Syncope and collapse

920

Contusion of unspecified part of head, initial encounter

964.2/E934.2

Poisoning by anticoagulants (e.g. warfarin), accidental (unintentional) initial encounter

969.03/E950.3

Poisoning by selective serotonin and norepinephrine reuptake inhibitors, intentional self-harm initial encounter

No Code

Underdosing of hydantoin derivatives (e.g. Dilantin), initial encounter

873.42

Unspecified open wound of other part of head, initial encounter

959.01

Injury, head, unspecified, initial encounter

847.0

Sprain of ligaments of cervical spine, initial encounter

883.0

Unspecified open wound of right ring finger without damage to nail, initial encounter

845.00

Sprain of unspecified ligament of left ankle, initial encounter

V58.32

Encounter for removal of sutures

V71.5

Encounter for examination and observation following alleged rape

E812.0

Car driver injured in collision with car, pick-up truck or van in traffic accident initial encounter

E826.0

Pedestrian on foot injured in collision with pedal cycle in traffic accident initial encounter

E888.0

Fall on same level from slipping, tripping and stumbling with subsequent striking against sharp glass initial encounter

Last Updated 06/2014

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