ICD-10 FAQs

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ICD-10 FAQs

How Long Has ICD-9-CM Been In Use?

ICD-9-CM was developed nearly and has been in use since 1979 ago and is obsolete. It cannot accurately describe the diagnoses and inpatient procedures of care delivered in the 21st century. The World Health Organization (WHO) developed the international standard.

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What Code Set Does ICD-9-CM Define?

ICD-9-CM volumes 1 and 2 define the code set used to report inpatient and outpatient diagnoses.  ICD-9-CM volume 3 defines the code set used to report inpatient procedures.

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What Code Set Does ICD-10 Define?

ICD-10-CM (Clinical Modification) defines the code set used to report inpatient and outpatient diagnosis.  ICD-10-PCSb (Procedure Coding System) defines the code set used to report facility inpatient procedures.

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When was ICD-10-CM Created?

The WHO created the base ICD-10-© in 1994. The Clinical Modification (CM) was added in the U.S. by the National Center for Health Statistics to create ICD-10-CM for use in inpatient and outpatient diagnosis coding.

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What agency maintains ICD-10?

The ICD-10-CM code set is maintained by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC) for use in the United States.  It is based on ICD-10, which was developed by the World Health Organization (WHO) and is used internationally.  
The ICD-10-PCS code set is not used internationally and is maintained by CMS.

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Why is ICD-10 better than ICD-9?

ICD-10 contains an increased number of codes and categories that allow for a more specific and accurate representation of current and future medical diagnoses and procedures.

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How Do The Numbers of Diagnosis Codes Compare From ICD-9-CM to ICD-10-CM?

ICD-9-CM contains 13,000 3-5-character alphanumeric diagnosis codes with 855 code categories.  ICD-10-CM contains 68,000 3-7-character alphanumeric diagnosis codes with 2,033 code categories.

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How Do The Numbers of Procedure Codes Compare From ICD-9-CM to ICD-10-PCS?

ICD-9-CM contains 4,000 3-4-character numeric procedure codes.  ICD-10-PCS contains 87,000 7-character alphanumeric procedure codes.

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What Is The Current Status of ICD-10?

On August 22, 2008, the Department of Health and Human Services (HHS) announced a long-awaited proposed regulation that would replace the ICD-9-CM code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10 code sets, effective October 1, 2011. The NPRM is in the Federal Register and the final rule has been adopted. The compliance date at October 1, 2014.

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What Is The Code Structure of ICD-10-CM?

 

The ICD-10-CM code structure consists of:

  • 21 Chapters
  • V and E codes are incorporated into the main classification
  • Code Blocks begin chapters
  • Valid codes can be 3,4,5,6, or 7 characters (7th character is a code extension)
  • The first character is always a letter, and the following two characters are always numbers
  • The fourth and fifth characters can be numbers or letters
  • In some cases the fifth character can be a dummy place holder, represented by an “X”
  • Some modifications are the same as ICD-9-CM, while other ICD-9-CM modifications have been removed
  • Injury codes have been expanded:
    • Fifth digit defines type of injury
    • Sixth digit defines laterality
    • Seventh digit defines encounter

Structural Differences Between the Two Coding Systems

1.  Diagnoses Codes
ICD-9-CM diagnoses codes are 3 – 5 digits in length with the first digit being alpha (E or V) or numeric and digits 2 – 5 being numeric. For example:
496 – Chronic airway obstruction not elsewhere classified (NEC);
511.9 – Unspecified pleural effusion; and
V02.61 – Hepatitis B carrier.

ICD-10-CM diagnoses are 3 – 7 digits in length with the first digit being alpha, digits 2 and 3 being numeric and digits 4 – 7 are alpha or numeric. The alpha digits are not case sensitive. For example:
A66 – Yaws;
A69.21 – Meningitis due to Lyme disease; and
S52.131a – Displaced fracture of neck of right radius, initial encounter for closed fracture. 

2.  Procedure Codes
ICD-9-CM procedures are 3 – 4 digits in length and all digits are numeric. For example:
43.5 – Partial gastrectomy with anastomosis to esophagus; and
44.42 – Suture of duodenal ulcer site.

ICD-10-PCS procedures are 7 digits in length with each of the 7 digits being either alpha or numeric. The alpha digits are not case sensitive. Letters O and I are not used to avoid confusion with the numbers 0 and 1. For example:
0680ZZ – Division, inferior vena cava, open; and
0DQ107Z – Repair, esophagus, upper, open with autograft.

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What Classification System Do Other Countries Use For Medical Coding?

All other developed countries use ICD-10. Currently 99 countries are using ICD-10 for both mortality and morbidity.

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Is Switching to ICD-10 Really Necessary?

Yes. The US needs to switch to ICD-10 in order to improve the quality of our nation’s healthcare data and to maintain clinical data comparability with the rest of the world. The longer we continue to use ICD-9, the more difficult it becomes to compile and share accurate disease and mortality data at a time when such global data sharing is critical for public health. The better data provided by ICD-10 will lead to improved patient safety, improved quality of care, and improved public health and bio-terrorism monitoring.

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Why Is It Important To Expedite Adoption and Implementation of ICD-10?

There is a cost and a danger to using an outdated, “broken” coding system. Continuing to use ICD-9-CM will increasingly have an adverse impact on the value of healthcare data including the accuracy of decisions based on faulty or imprecise data.

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Won’t switching to ICD-10 be complicated?

An AHIMA/AHA field study shows ICD-10 can be implemented without excessive staff training costs or changes in documentation practices. Training ICD-9 users to use ICD-10 has been shown to be relatively straightforward.

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What impact will switching to ICD-10 have on the Revenue Cycle?

Nearly all operational systems in healthcare and their administration processes will be affected by the implementation of ICD-10. U.S. health care organizations have much to consider before deciding how to address ICD-10 compliance.

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Will the benefits of ICD-10 really outweigh the costs of implementation?

An independent study concluded that the benefits of ICD-10 are likely to exceed initial implementation costs within just a few years. Furthermore, the cost of doing nothing may be greater than actual implementation. Any delay in adoption of ICD-10 will cause an increase in future implementation costs as the management of health information becomes increasingly electronic and costs of implementing new coding systems increases due to required systems and applications upgrades.

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Will Passport Health Communications, Inc. support ICD-10-CM in all of its products?

Yes – Passport will follow the implementation of this coding system very closely and will implement ICD-10 according to the CMS prescribed guidelines.

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Will there be a grace period for implementation of ICD-10 compliance?

October 1, 2014 is the compliance date for implementation of ICD-10-CM (diagnoses) and ICD-10-PCS (procedures) codes for services provided on or after October 1, 2014. There will be no delays and no grace period. 

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When will ICD-9 codes stop being accepted?

ICD-9-CM codes will not be accepted for services provided on or after October 1, 2014.
Note: ICD-10 codes will not be accepted for services prior to October 1, 2014.

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Will ICD-10 have an impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes?

No, ICD-10 will not have an impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. CPT and HCPCS codes will continue to be used for physician and ambulatory services, respectively.

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Will there be a cost associated with the conversion to the ICD-10 code Set?

No - There are no customer costs anticipated with the conversion to the ICD-10 code set.

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