ICD-10 Overview

ICD-10 Coding Transition OverviewOn October 1, 2015, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. ICD-10 consists of two parts:

• ICD-10-CM diagnosis coding which is for use in all U.S.
  health care settings.
• ICD-10-PCS inpatient procedure coding which is for use in U.S.
  hospital settings.

ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims.

Note: The change to ICD-10 does not affect CPT coding for outpatient procedures.

Submission Dates

Claims for services provided on or after the compliance date (October 1, 2015) should be submitted with ICD-10 diagnosis codes.
Claims for services provided prior to the compliance date (October 1, 2015) should be submitted with ICD-9 diagnosis codes.

Easing the Transition

To help ease the ICD-10 transition, the Centers for Medicare & Medicaid Services (CMS) released guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set.

This guidance raised a number of questions, so CMS published answers to 13 of the most common.

ICD-9 to ICD-10 Conversion

It is important to understand the major improvements and changes between ICD-9 and ICD-10 diagnosis codes. To help organizations prepare for the transition and then use ICD-10 starting October 1, 2015, PGM Billing developed an ICD-10 code conversion tool that allows users to convert ICD-9 to ICD-10 codes and vice versa by selecting the ICD conversion type followed by a user defined code. The tool also includes an ICD-10 codes lookup feature that allows user to perform ICD-10 code searches to obtain the correct code and description. Search using either the complete or partial ICD-10 code as well as any number of keywords to describe the specified code.

Here are some general differences between ICD-9 and ICD-10:

ICD-9-CM Diagnosis Codes	ICD-10-CM Diagnosis Codes
No Laterality	Laterality – Right or Left account for >40% of codes
3-5 digits First digit is alpha (E or V) or numeric Digits 2-5 are numeric Decimal is placed after the third character	7 digits Digit 1 is alpha; Digit 2 is numeric Digits 3–7 are alpha or numeric Decimal is placed after the third character
No placeholder characters	“X” placeholders
14,000 codes	69,000 codes to better capture specificity
Limited Severity Parameters	Extensive Severity Parameters
Limited Combination Codes	Extensive Combination Codes to better capture complexity
1 type of Excludes Notes	2 types of Excludes Notes

Other Important Changes to Note in ICD-10-CM

• Importance of Anatomy: Injuries are grouped by anatomical site rather than by type of injury.
• Incorporation of E and V Codes: The codes corresponding to ICD-9-CM V codes (Factors Influencing Health Status and Contact with Health Services) and E codes (External Causes of Injury and Poisoning) are incorporated into the main classification rather than separated into supplementary classifications as they were in ICD-9-CM.
• New Definitions: In some instances, new code definitions are provided reflecting modern medical practice (e.g., definition of acute myocardial infarction is now 4 weeks rather than 8 weeks).
• Restructuring and Reorganization: Category restructuring and code reorganization have occurred in a number of ICD-10-CM chapters, resulting in the classification of certain diseases and disorders that are different from ICD-9-CM.
• Reclassification: Certain diseases have been reclassified to different chapters or sections in order to reflect current medical knowledge.