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, on Oct. 1, 2014.
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 on Oct. 1, 2014. 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
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
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
|Volume of codes
|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
||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
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.
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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
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
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
Additional information about ICD-10 can be found through the
for Medicare & Medicaid Services
Information Management Systems Society