icd-10 transition made easier

What is ICD-10?
ICD-10 is a diagnostic coding system implemented by the World Health Organization (WHO) in 1993 to replace ICD-9, which was developed by WHO in the 1970s. ICD-10 is in almost every country in the world, except the United States.

When we hear “ICD-10” in the United States, it usually refers to the U.S. clinical modification of ICD-10: ICD-10-CM. This code set is scheduled to replace ICD-9-CM, our current U.S. diagnostic code set, no sooner than Oct. 1, 2015.

Another designation, ICD-10-PCS, for “procedural coding system,” is will also be adopted in the United States. ICD-10-PCS will replace Volume 3 of ICD-9-CM as the inpatient procedural coding system. Current plans would see CPT remain the coding system for physician services.

More information on WHO’s ICD-10 code set can be found at http://www.who.int/classifications/icd/en/.

When will ICD-10-CM and ICD-10-PCS be implemented?
The Department of Health and Human Services (HHS) announced on August 15, 2008, a long-awaited proposed regulation that would replace the ICD-9-CM code sets now used to report healthcare diagnoses and procedures with greatly expanded ICD-10-CM (diagnosis) and ICD-10-PCS (hospital procedure) code sets. In a separate proposed regulation, HHS has proposed adopting the updated X12 standard, Version 5010, and the National Council for Prescription Drug Programs standard, Version D.0, for electronic transactions, such as healthcare claims. Version 5010 is essential to use of the ICD-10 codes.

The Centers for Medicare and Medicaid Services (CMS) announced in January that ICD-10-CM will be implemented into the HIPAA mandated code set no sooner than Oct. 1, 2015. The American Academy of Professional Coders (AAPC) lobbied successfully to delay implementation beyond its initial 2010 proposed date, and more recently to delay a proposed 2011 date, believing that it would create undue hardships in the industry, as it falls too soon on the heels of other significant regulatory changes that have burdened providers in recent years.

Why is the United States moving to ICD-10-CM?

ICD-9-CM has several problems. Foremost, it is out of room. Because the classification is organized scientifically, each three-digit category can have only 10 subcategories. Most numbers in most categories have been assigned diagnoses. Medical science keeps making new discoveries, and there are no numbers to assign these diagnoses.

Computer science, combined with new, more detailed codes of ICD-10-CM, will allow for better analysis of disease patterns and treatment outcomes that can advance medical care. These same details will streamline claims submissions, since these details will make the initial claim much easier for payers to understand.

How is ICD-10-CM different from our current system?
In many ways, ICD-10-CM is quite similar to ICD-9-CM. The guidelines, conventions, and rules are very similar. The organization of the codes is very similar. Anyone who is qualified to code ICD-9-CM should be able to easily make the transition to coding ICD-10-CM.

Many improvements have been made to coding in ICD-10-CM. For example, a single code can be found to report a disease and its current manifestation (i.e., type II diabetes with diabetic retinopathy). In fracture care, the code differentiates an encounter for an initial fracture; follow-up of fracture healing normally; follow-up with fracture in malunion or nonunion; or follow-up for late effects of a fracture. Likewise, the trimester is designated in obstetrical codes.

While much has been said about the huge increase in the number of codes under ICD-10-CM, some of this growth is due to laterality. While an ICD-9-CM code may identify a condition of, for example, the ovary, the parallel ICD-10-CM code identifies four codes: unspecified ovary, right ovary, left ovary, or bilateral condition of the ovaries.

The big differences between the two systems are differences that will affect information technology and software at your practice. Here’s a chart showing the differences:

Issue ICD-9-CM ICD-10-CM
Volume of codes Approximately 13,600 Approximately 69,000
Composition of codes Mostly numeric, with E and V codes alphanumeric. Valid codes of three, four or five digits. All codes are alphanumeric, beginning with a letter and with a mix of numbers and letters thereafter. Valid codes may have three, four, five, six or seven digits.
Duplication of code sets Currently, only ICD-9-CM codes are required. No mapping is necessary. For a period of up to two years, systems will need to access both ICD-9-CM codes and ICD-10-CM codes as the country transitions from ICD-9-CM to ICD-10-CM. Mapping will be necessary so that equivalent codes can be found for issues of disease tracking, medical necessity edits and outcomes studies.

What can I do to prepare for ICD-10-CM?
While there will need to be significant education and training for physicians, coders and other healthcare personnel to fully implement this major code change, no one needs to panic. Other organizations are already attempting to capitalize on the situation by suggesting that coders should begin training immediately. ICD-10 Hub does not believe such an approach is either necessary or prudent since it will likely be difficult to remember in three or four years what you were trained on today.

The AAPC has developed a plan to provide accurate and timely assistance to permit practices to effectively implement ICD-10 on time. The plan is broken down by year (2009 – 2013) and includes a variety of delivery methods, such as Webinars, audio conferences, onsite training and national and regional conferences. A team of leading coding and ICD-10 experts developed the plan, which is broken into benchmarked steps.

As part of the implementation plan, the AAPC has provided its members with a “Personal Progress Tracker,” which gives members the ability to easily enter in personal progress with red, yellow and green lights that indicate whether the member is on schedule or not. More information, including the detailed plan and training program, is available on the AAPC’s Web site at http://www.aapc.com/ICD-10/training.aspx.

For now, sign up for Coding Edge magazine, the EdgeBlast e-newsletter and bookmark this site to keep up with the latest news and training plans.

When should I begin comprehensive code-set training?
AAPC recommends that comprehensive code-set training should take place closer to the October 1, 2014 implementation date for three reasons:

  • It is difficult to remember codes that are not being currently used for a lengthy period of time.
  • The ICD-10 codes are still changing and will not be frozen until October 1, 2011 (2012 codes).
  • Your money will be better spent later.

To accommodate the needs of implementation teams, instructors, and others working on ICD-10 implementation, AAPC will begin offering a small number of code-set classes in Fall 2011.

Am I going to have to sit for my CPC (-H, -P) again to keep my AAPC credential once ICD-10-CM is implemented?
To ensure employers continue to have confidence in CPC's ability to accurately code the current code sets, once ICD-10 is implemented (thus protecting all 60,000 credential holders), and that those credentials truly represent one’s ability to code under the current code set, AAPC members holding a credential will have two years to pass an open-book, online ICD-10 proficiency test. Visit AAPC’s site for more information.

What about ICD-10-PCS?
ICD-10-PCS is a code set designed to replace Volume 3 of ICD-9-CM for inpatient procedure reporting. It will be used by hospitals and by payers. ICD-10-PCS is significantly different from Volume 3 and from CPT® codes and will require significant training for users. The system was designed by 3M Health Information Management for the Centers for Medicare and Medicaid.

ICD-10-PCS will not affect coding of physician services in their offices. However, physicians should be aware that documentation requirements under ICD-CM-PCS are quite different, so their inpatient medical record documentation will be affected by this change.

ICD-10-PCS has nearly 71,000 seven-digit alpha-numeric codes. Codes are selected from complex grids, based on the type of procedure performed, approach, body part, and other characteristics. The code system does not use medical terminology based on Latin or eponyms. More information on ICD-10-PCS, including an informative PowerPoint presentation that describes the coding system, can be found at http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/08_ICD10.asp

Where can I find additional information about ICD-10?
Additional information about ICD-10 can be found through the following websites:

American Medical Association

Centers for Medicare & Medicaid Services

Health Information Management Systems Society


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ICD-10 Hub is a leading source of information about ICD-10 news and events. Sponsored by the AAPC, Navicure and Practice Management Institute (PMI), this website is dedicated to being an essential resource to help practices and HIT vendors understand how this transition will impact the entire industry and how every organization can properly prepare.
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