COMPARASIONS BETWEEN ICD-9-CM AND ICD-10-CM BY: DEANNA NEFF, RHIT

1. NvHIMA 2012 ANNUAL CONVENTION WINDS OF CHANGE II COMPARASIONS BETWEEN ICD-9-CM AND ICD-10-CMBY: DEANNA NEFF, RHIT

2. As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10). The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule. HHS will announce a new compliance date moving forward. HHS Announces Intent to Delay ICD-10-CM Compliance Date

3. ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of two parts: 1. ICD-10-CM for diagnosis coding  ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar. The transition to ICD-10-CM is occurring because ICD-9-CM produces limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9-CM is 30 years old, has outdated terms, and is inconsistent with current medical practice. Also, the structure of ICD-9-CM limits the number of new codes that can be created, and many ICD-9-CM categories are full. Who Needs to Transition  ICD-10-CM will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims. Everyone covered by HIPAA who transmits electronic claims must also switch to Version 5010 transaction standards. The change to ICD-10-CM does not affect CPT coding for outpatient procedures. About ICD-10-cm

4. ICD-10-CM to ICD-9-CM and ICD-9-CM to ICD-10-CM 2012 Version Diagnosis Code Set General Equivalence Mappings

5. Since there is no large scale database available that contains diagnosis and procedure data coded in ICD-10-CM, it was necessary to create a simulated ICD-10-CM database by using the General Equivalence Mappings (GEMs). The GEMs are a comprehensive, translation dictionary between ICD-9-CM and ICD-10-CM. Taking the complete meaning of a code as a single unit, the GEMs identify the most appropriate translation(s) to the other code set. There is an ICD-9-CM to ICD-10-CM GEM and an ICD-10-CM to ICD-9-CM GEM for both diagnoses and procedures. CMS has posted the GEMs on its website (CMS, 2010, C). Converting MS-DRGs 26.0 to ICD-10-CM and ICD-10-PCS

6. General Equivalence Mappings Also known as GEM’s

7. ICD-9-CM and ICD-10-CM Code Sets Compared: Code Length and Set Size Comparison Diagnosis Codes and Levels of Specificity

8. ICD-10-CM codes may be longer, and there are about five times as many codes. Consequently, in an unabridged ICD-9-CM to ICD-10-CM mapping, each ICD-9-CM code is typically linked to more than one ICD-10-CM code, because each ICD-10-CM code is more specific. ICD-10-CM is much more specific than ICD-9-CM, and, just as important for purposes of mapping, the level of precision in an ICD-10-CM code is more consistent within clinically pertinent ranges of codes. In ICD-9-CM, on the other hand, the level of detail among code categories varies greatly. Diagnosis Codes and Levels of Specificity

9. What are the differences between ICD-9-CM and ICD-10-CM Conventions, General Coding Guidelines and Chapter Specific Guidelines ICD-10-CM Official Guidelines for Coding and Reporting 2012

10. XXX .XXX X    Category Etiology, Extension anatomic site, severity CODE STRUCTURE ICD-10-CM

11. ICD-10-CM is divided into two main parts: The Index to Disease and the Tabular List. The Index is referred to as the Alphabetic Index, and it contains diseases, conditions and injuries. The order of the ICD-10-CM chapters will be a little different than in ICD-9-CM. The tabular list has 21 chapters in ICD-10-CM verses the 17 chapters in ICD-9-CM. The External Causes of Morbidity, Chapter 20 and Factors Influencing Health Status and Contact with Health Services, Chapter 21 are no longer considered to be supplementary but are now a part of the core classification. One will also notice that some of the titles have changed as well. For instance “Mental Disorders” is now “Mental and Behavioral Disorders”. Tabular list

12. CHAPTER TITLES

13. These conventions are incorporated within the Alphabetic Index and Tabular List of the ICD-10-CM as instructional notes. The Alphabetic Index and Tabular List The ICD-10-CM is divided into the Alphabetic Index, an alphabetical list of terms and their corresponding code, and the Tabular List, a chronological list of codes divided into chapters based on body system or condition. The Alphabetic Index consists of the following parts: the Index of Diseases and Injury, the Index of External Causes of Injury, the Table of Neoplasms and the Table of Drugs and Chemicals. Conventions for the ICD-10-CM

14. CODING CONVENTIONS

15. CODING CONVENTIONS

16. CODING CONVENTIONS

17. CODING CONVENTIONS

18. CODING CONVENTIONS

19. CODING CONVENTIONS

20. K70 Alcoholic liver disease K71 Toxic liver disease K72 Hepatic failure, not elsewhere classified K73 Chronic hepatitis, not elsewhere classified EXAMPLE NEC EXCLUDES 1 alcoholic hepatitis (chronic) (K70.1-) drug induced hepatitis(chronic) (K71.-) granulomatous hepatitis (chronic) NEC (K75.3) reactive, nonspecific hepatitis (chronic) (K75.2) viral hepatitis (chronic) (B15-B19)

21. J40 Bronchitis, not specified as acute or chronic EXAMPLE NOS INCLUDES bronchitis NOS catarrhal bronchitis bronchitis with tracheitis NOS tracheobronchitis NOS

22. CODING CONVENTIONS

23. C22 Malignant neoplasm of liver and intrahepatic bile ducts Colon: EXCLUDES 1 Malignant neoplasm of biliary tact NOS (C24.9) Secondary malignant neoplasm of liver and intrahepatic bile duct (C78.7) Use additional code to identify: alcohol abuse and dependence (F10.-) hepatitis B (B16.-, B18.0-B18.1) hepatitis C (B17.1-, B18.2)

24. CODING CONVENTIONS

25. CODING CONVENTIONS

26. CODING CONVENTIONS

27. CODING CONVENTIONS Commas are found in both ICD-10-CM and ICD-9-CM for the same reason. Words following a comma are often essential modifiers. For example the term “postpartum” is an essential modifier and must be present in the statement for deep-vein thrombosis or pelvic thrombophlebitis to assign code O87.1. O87.1 Deep phlebothromosis in the puerperium Deep-vein thrombosis, postpartum Pelvic thrombophlebitis, postpartum Commas also appear in code descriptions as essential modifiers: O88.011 Air embolism in pregnancy, first trimester

28. General Coding Guidelines

29. General Coding Guidelines

30. General Coding Guidelines

31. General Coding Guidelines

32. General Coding Guidelines

33. General Coding Guidelines

34. General Coding Guidelines

35. General Coding Guidelines

36. General Coding Guidelines

37. General Coding Guidelines

38. General Coding Guidelines

39. Chapters in icd-9-cm

40. CHAPTERS IN ICD-10-CM

41. 3-Character Complete Codes A few categories exist that are at the highest level of specificity with just the 3-character code. Here are some examples: A35 Other tetanus Tetanus NOS E54 Ascorbic acid deficiency N10 Acute tubulo-interstitial nephritis OVERVIEW OF FORMAT AND STRUCTURE

42. 4-Character Subcategories The 4 character subcategories further define the site, etiology, and manifestation or state of the disease or condition. The 4-character subcategory includes the 3-character category plus a decimal point followed by and additional character to further identify the condition to a higher level of specificity. (C15.3 Malignant neoplasm of upper third esophagus) OVERVIEW OF FORMAT AND STRUCTURE

43. 5 – and 6 – Character Subcategories In ICD-9-CM, the fifth digit was the most precise level of specificity. In ICD-10-CM, fifth or sixth character subclassifications represent a level of further specificity. Coding to the fifth and sixth character gives more information about the condition or diagnosis. 5th (J10.89 Influenza due to the other identified influenza virus with other manifestations) 6th (S55.011 Laceration of ulnar artery at forearm level, right arm) OVERVIEW OF FORMAT AND STRUCTURE

44. Seventh Character Extension Some ICD-10-CM categories, such as injuries and poisonings, require a seventh character extension. Notes in the Tabular List identify codes that require a seventh character. A dummy placeholder consisting of the letter “X” is used if the code category does not specify a sixth character. (T41.5x2A – Poisoning by therapeutic gases, intentional self-harm, initial encounter) OVERVIEW OF FORMAT AND STRUCTURE

45. The seventh character in these examples explains: A initial encounter D subsequent encounter S sequela Note: The “x” in code T41.5x2A is a dummy placeholder. The “x” may be used as a dummy placeholder to reach the highest level of specificity when a sixth or seventh character is required. The “x’ is used as a fifth or sixth character placeholder to allow for future expansion of the code set. Some codes have dummy placeholders built into the code. (033.5xx0 – Maternal care for disproportion due to unusually large fetus, not applicable or unspecified) OVERVIEW OF FORMAT AND STRUCTURE

46. X75.xxxS Intentional self harm by explosive material, sequelae W22.042S Striking against wall of swimming pool causing other injury, sequelae. X95.01A Assault by airgun discharge, initial encounter (invalid) The ICD-10-CM code must have the dummy place holder added in order to add the seventh character to be a valid code. X95.01xA - Assault by airgun discharge, initial encounter ALPHA EXTENSIONS

47. The appropriate 7th character is to be added to each code R40.21-, R40.22-, and R40.23-, 0 unspecified time 1 in the field [EMT or ambulance] 2 at arrival to emergency department 3 at hospital admission 4 24 hours or more after hospital admission R30.2121 Coma scale, eyes open, to pain, in the field R40.2222 Coma scale, best verbal response, incomprehensible words, at arrival to emergency department R40.2334 Coma scale, best motor response, abnormal, 24 house or more after hospital admission. Coma extensions

48. 0 not applicable or unspecified 1 Fetus 1 2 Fetus 2 3 Fetus 3 4 Fetus 4 5 Fetus 5 9 Other Fetus O40.2xx1 Polyhydramnios, second trimester, fetus 1 FETUS IDENTIFICATION IN MULTIPLE GESTATIONS

49. FRACTURES

50. Type I open fracture. Wound less than 1 cm, without contamination and minimal injury of soft tissue. Type II open fracture. Wound between 1 and 10 cm, mild contamination extensive soft tissue damage and minimal to moderate crushing component. Type III-A open fracture. Wound larger than 10 cm, severe contamination and severe crushing component. Type III-B open fracture. Wound larger than 10 cm, severe contamination and severe loss of tissues. Type III-C open fracture. Wound larger than 10 cm, severe contamination and neurovascular injury. gustilo Fracture classification