What are ICD 10 Codes?
ICD 10 codes are 3 to 7 characters. The first character is alphabetic, the 2nd through 7th are either alphabetic or numeric, with a decimal after 3 characters. These codes are arranged in chapters and sub-chapters with diseases grouped by letter.
ICD 10 allows increased detail and the flexibility for emerging diagnosis. It is robust and has a logical structure with clear consistent definitions. It allows over 155,000 diagnosis codes compared to a maximum of 17,000 ICD 9 codes.
ICD-9 codes are nearly 30 years old and limited in that they cannot be expanded any further for diagnosis. Many of its diagnosis categories are full. ICD 9 codes are 3 to 5 characters. The first can be numeric or alpha, the 2nd through 5th are numeric with a decimal after the third character.
ICD-9 will no longer be maintained after implementation of ICD 10. ICD 10 is currently in use by other countries and is updated annually just like ICD 9.
The greater number of codes in ICD 10 will make it easier to find the right diagnosis codes. With improved structure and specificity, it should be easier to use than ICD 9. Most practices use a relatively small number of codes related to the type of specialty.
Organization of ICD-10 Codes
ICD 10 codes are organized in 22 chapters as listed below:
- 1: A00-B99 – Certain infectious and parasitic diseases
- 2: C00-D48 – Neoplasms
- 3: D50-D89 – Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
- 4: E00-E90 – Endocrine, nutritional and metabolic diseases
- 5: F01-F99 – Mental and behavioral disorders
- 6: G00-G99 – Diseases of the nervous system
- 7: H00-H59 – Diseases of the eye and adnexa
- 8: H60-H95 – Diseases of the ear and mastoid process
- 9: I00-I99 – Diseases of the circulatory system
- 10: J00-J99 – Diseases of the respiratory system
- 11: K00-K93 – Diseases of the digestive system
- 12: L00-L99 – Diseases of the skin and subcutaneous tissue
- 13: M00-M99 – Diseases of the musculoskeletal system and connective tissue
- 14: N00-N99 – Diseases of the genitourinary system
- 15: O00-O99 – Congenital malformations, deformations and chromosomal abnormalities
- 16: P00-P96 – Certain conditions originating in the perinatal period
- 17: Q00-Q99 – Congenital malformations, deformations and chromosomal abnormalities
- 18: R00-R99 – Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
- 19: S00-T98 – Injury, poisoning and certain other consequences of external causes
- 20: V01-Y98 – External causes of morbidity and mortality
- 21: Z00-Z99 – Factors influencing health status and contact with health services
- 22: U00-U99 – Codes for special purposes
Part of HIPAA
HIPAA legislation included the requirement for use of ICD 10 with a compliance date of October 1, 2013 for implementation. This compliance date was then delayed until October of 2015. The government agency requiring implementation is the Department of Health and Human Services (HHS). HHS has no plans to delay implementing.
Related to the switch to ICD 10 is the transition to the version 5010 standard for electronic transactions effective January 1, 2012. The 5010 changes are necessary to accommodate ICD 10 codes and NPI.
ICD 10 Code Concerns
The issues concerning most providers and billing services in transitioning to ICD-10 are the potential economic impact. Will practice management systems, clearinghouses, and insurance payers be able to accommodate the greater number of diagnosis codes (up to 155,000) for ICD 10?
Will payers that don’t yet use ICD 10 codes map everything back to ICD 9 for processing?
Another complication is that some ICD 10 codes are unique to the encounter. So the initial patient visit may use one ICD 10 code while subsequent visits will require another.
It will take healthcare providers, coders, and billers an estimated 6 months or more to become proficient with ICD 10.
Fraud & Waste?
Henry Percy wrote an interesting blog piece recently called “War against Doctors“. He raised a very good point regarding the 70,000 new diagnosis codes to be introduced as a part of ICD-10. He contends there will be a whole new round of seminars put on by consultants on how to maximize revenue and game the system through “proper” coding.
Contributing to this is the Medicare practice referred to as “Pay and Chase”. This is where a provider is paid, and later chased down for a refund if an error or fraud has been determined. As you can imagine it’s more difficult to recoup the payment after it’s been made.
CMS Mapping
CMS and CDC have developed a crosswalk (or mapping) tool from ICD-9 to ICD 10-CM/PCS diagnosis codes for use by all payers and providers. It’s available at the CMS Website.