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Jennifer Ruhl, RHIT, CCS, CTR (NCI SEER) Steve Peace, BS, CTR (Univ. of Miami)

ICD-9-CM and ICD-10 Updates and U.S. Adoption of ICD-10-CM Coding Standard: Major Changes in Health Information Coding Practice and Implications for Cancer Surveillance. Jennifer Ruhl, RHIT, CCS, CTR (NCI SEER) Steve Peace, BS, CTR (Univ. of Miami). Overview. ICD-9-(CM) coding resources

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Jennifer Ruhl, RHIT, CCS, CTR (NCI SEER) Steve Peace, BS, CTR (Univ. of Miami)

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  1. ICD-9-CM and ICD-10 Updates and U.S. Adoption of ICD-10-CM Coding Standard:Major Changes in Health Information Coding Practice and Implications for Cancer Surveillance Jennifer Ruhl, RHIT, CCS, CTR (NCI SEER) Steve Peace, BS, CTR (Univ. of Miami)

  2. Overview • ICD-9-(CM) coding resources • ICD-10 coding resources • Introduction of ICD-10-CM

  3. ICD-9-(CM) and ICD-10 • Uses of medical coding systems for cancer registrars: • Casefinding • Case matching • Record & tumor linkage • Death certificate coding • Follow up and treatment • Special studies

  4. Updates to ICD-9-CM/ICD-10 • ICD-9-CM: Bi-annual updates • Minor update April • Major update October • ICD-10 • Scheduled for every three years

  5. Cancer Registry Sources using ICD-9-CM/ICD-10 • ICD-9-CM casefinding list • ICD-9-(CM) to ICD-10 • ICD-10 to ICD-9-(CM) • ICD-O-3 to ICD-9-(CM) • ICD-O-3 to ICD-10

  6. ICD-9-CM Casefinding list • Updated in 2009 and 2010 and includes: • neoplasm codes (malignant, in-situ, benign, borderline) • cancer related diseases • personal history codes • Reviewed by SEER registries • Reviewed by representatives from AJCC CoC and NPCR CDC • Next update due January 1, 2011 • http://www.seer.cancer.gov/tools/casefinding/index.html

  7. ICD-9-(CM) to ICD-10 andICD-10 to ICD-9-(CM) • Major update 2009-2010 • Incorporated all coding changes since last update (mid 1990s) • Will be posted to SEER website August 2010

  8. ICD-9-CM to ICD-10 andICD-10 to ICD-9-CM • Based on 2010 ICD-9-CM Casefinding list • All codes from casefinding list are represented • General Equivalency Mappings (GEMs) used to update • GEMs provided by CMS

  9. What are the GEMS? • Developed by CMS as a tool to assist with the conversion of ICD-9-CM to ICD-10-CM • Includes: • One to one mapping • One to many mapping

  10. What are the GEMS, cont. • Intended audiences include: • Coding professionals • Payers/Providers • Medical researcher • Use of GEMS • Converting payment system • Payment and coverage edits • Quality measures

  11. ICD-9-CM to ICD-10 andICD-10 to ICD-9-CM • File layout: • Type of Code • Reportable • Supplemental • ICD-9/10 Category Code • ICD-9/10 Term (code description)

  12. ICD-9-CM to ICD-10 andICD-10 to ICD-9-CM • Additional reviewers included: • SEER Cancer Registries • Leah Driscoll, CTR (Kentucky) • Frances Ross, BA, CTR (Kentucky) • Westat (Rockville, MD) • Mary Mesnard, BS, RHIA, CTR • Annette Stephens, BA, BS, RHIA • IMS (Silver Spring, MD) • Rashid Aminou, MS • Nicki Schussler, BS

  13. Our ICD-9-CM/ICD-10 Experts • ICD-9-CM • Amy Blum, MHSA, RHIA, CTR • Medical Systems Specialist, National Center for Health Statistics (NCHS) • ICD-10 • Carolyn Watkins • Certified Nosologist • Kenneth D. Kochanek, Statistician • Mortality Statistics Branch, National Center for Health Statistics (NCHS)

  14. Upcoming projects: • ICD-10 COD Casefinding list • Release date July 2010 • ICD-O-3* to ICD-9-(CM) • Scheduled completion: 2011 • ICD-O-3* to ICD-10 • Scheduled completion: 2011 • *Includes new Hematopoietic codes

  15. ICD-10-CM • U.S. implementation October 1, 2013 • Based on ICD-10 • Alphanumeric codes • Major changes include: • Laterality coding • New code categories

  16. ICD-9-CM vs. ICD-10-CM • ICD-9-CM • Numerically based • 30 year old coding system • Running out of room for new codes (currently about 11,000 codes) • ICD-10-CM • Alphanumerically based • Less than 20 year old coding system • Ample room for expansion (currently greater than 60,000+ codes)

  17. ICD-9-CM vs. ICD-10-CM • ICD-9-CM • Limited specificity (only up to 5 digit codes) • Using 30 year old medical terminology • Laterality not included for applicable cancer codes • ICD-10-CM • Greater specificity (up to 7 digit codes) • Updated to current medical terminology • Laterality included for applicable cancer codes • Provides codes for many conditions not included in ICD-9-CM

  18. Example: Breast, unspecified site • ICD-9-CM code: 174.9 • ICD-10 code: C50.9 • ICD-10-CM codes: • C50.911: unspecified right female • C50.912: unspecified left female • C50.919: unspecified side female

  19. Example: Low grade MDS • ICD-9-CM code: 238.72 • ICD-10 code: D46.7 • ICD-10-CM codes: • D46.a Refractory cytopenia with multilineage dysplasia • D46.b Refractory cytopenia with multilineage dysplasia and ringed sideroblasts

  20. ICD-10-CM • Preparing the Cancer Registry field • Committee to be formed representing all the Cancer Registry field standard setters • Goal of committee to determine best way to educate cancer registrars about ICD-10-CM

  21. ICD-10-CM Resources • ICD-10-CM casefinding list • Planned first appearance is January 1, 2013, in conjunction with 2013 ICD-9-CM casefinding list • ICD-9-CM to ICD-10-CM • ICD-10-CM to ICD-10 • ICD-O-3 to ICD-10-CM

  22. ICD-10-PCS • Replacing outdated coding system for procedure codes • Alphanumeric codes • Up to 7 digit long • Codes “developed” through table selection process

  23. Resources • ICD-10-CM (CMS website) • http://www.cms.gov/ICD10/12_2010_ICD_10_CM.asp • ICD-10-PCS (CMS website) • http://www.cms.gov/ICD10/13_2010_ICD10PCS.asp#TopOfPage

  24. Conclusion • ICD-9-CM and ICD-10 resources published by SEER undergoing major updates • Planning for ICD-10-CM

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