Provider Alert – ICD-10 is coming 10/1
April 8, 2015 edition – In an ongoing effort to keep our Providers informed of upcoming changes, HPSJ would like to take this opportunity to once again remind you of the coming transition to ICD 10. We hope you’re ready!
Why change?
The periodic revisions of ICD-9-CM mirror changes in the medical and healthcare field. The U.S. has been using ICD-9-CM since 1979, and it is not sufficiently robust to serve the healthcare needs of the future. The content is no longer clinically accurate and has limited data about patients’ medical conditions and hospital inpatient procedures, the number of available codes is limited, and the coding structure is too restrictive. The U.S. cannot directly compare morbidity diagnosis data to state and national mortality data, because mortality data have already transitioned to ICD-10 code sets. Further, most developed countries have already made the transition to ICD-10 code sets, so the U.S. cannot compare U.S. morbidity diagnosis data at the international level.
ICD-10-CM/PCS code sets will enhance the quality of data for:
- Tracking public health conditions (complications, anatomical location)
- Improved data for epidemiological research (severity of illness, co-morbidities)
- Measuring outcomes and care provided to patients
- Making clinical decisions
- Identifying fraud and abuse
- Designing payment systems/processing claims
Code Set Differences
There are currently 13,000 diagnosis codes in ICD-9. ICD-10 has approximately 69,000 diagnosis codes. Other Code Structure Changes are as follows:
| OLD | NEW |
| 3-5 characters | 3-7 characters |
| First character is numeric or alpha | Character 1 is alpha |
| Characters 2-5 are numeric | Character 2 is numeric |
| Character 3-7 can be alpha or numeric |
| Examples: | OLD | NEW |
| Abdominal Rebound Tenderness RUQ | 789.61 | R10.821 |
| Type II Diabetes Mellitus w/ketoacidosis | 250.10 | E08.10 |
| Ankle Fracture | 824.8 | M84.473A |
Certain categories in ICD-10 require the appropriate 7th digit be added. This 7th digit can indicate initial encounter, subsequent encounter, sequel, routine healing, delayed healing, etc.
The new code set provides a significant increase in the specificity of the reporting, allowing more information to be conveyed in a code, resulting in fewer codes needed to fully describe a condition. It enables reporting of laterality (right vs. left designations) reflecting the importance of which side of the body or limb is the subject of evaluation. It also restructures reporting of obstetric diagnoses in relation to the patient’s trimester of pregnancy vs. episode of care.
This is just a brief view of the changes to come. Documentation will be the key to ICD-10 and coding to the highest level of specificity. So, now’s the time to get ready!
ICD-10 Codes of the Month – Goofy Wonders
a. W61.12XA
b. V80.730A
a. Struck by macaw, initial encounter
b. Animal-rider injured in collision with streetcar, initial encounter