Welcome to ICD-10
After nearly 30 years, a new era of coding for diagnoses is coming—the International Classification of Diseases 9th Revision, Clinical Modification, or ICD-9, is running out of codes to manage the hundreds of new diagnosis codes that are submitted by specialty societies and quality monitoring agencies. The new set of codes identified as ICD-10 was approved by the Department of Health and Human Services and have greater specificity and epidemiological tracking for disease management with over 68,000 codes in its system. Presently, there are approximately 14,000 ICD-9-CM codes available.
The Centers for Medicare and Medicaid Services has stated that they are re-examining the current ICD-10 implementation deadline of October 1, 2013. In an effort to reduce all the regulatory burdens facing physicians acting administrator Marilyn Tavenner indicated that HHS will initiate postponing the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).
Structural Differences between the Two Coding Systems
| ICD-9-CM | ICD-10-CM |
|---|---|
| 3-5 characters | 3-7 characters |
| Approximately 14,000 codes | Approximately 68,000 codes |
| First digit may be alpha (E or V) or numeric. Digits 2-5 are numeric | Alphanumeric throughout |
| Limited space for new codes | Flexible to add new codes |
| Lacks detail | Very specific |
| Lacks laterality | Has laterality |
| Difficult to analyze data due to non-specific codes | Specificity improves coding accuracy and depth of data for analysis |
| Non-specific and does not adequately define diagnoses needed for medical research | Detail improves the accuracy of data used in medical research |
| Does not support interoperability because it is not used in other countries | Supports interoperability and the exchange of health care data between other countries and the United States |
Coding example:
| ICD-9-CM | ICD-10-CM |
|---|---|
| 725 Polymyalgia Rheumatica | M35.3 Polymyalgia Rheumatica |
| 135 Sarcoidosis | D86.0 Sarcoidosis of lung D86.86 Sarcoidosis arthropathy D86.87 Sarcoidosis Myositis |
| 715.14 Primary Localized Osteoarthrosis hand |
M18.0 Bilateral primary osteoarthritis 1 CMC joints M18.10 Uni primary osteoarthritis 1 CMC unspecified joint M18.11 Uni primary osteoarthritis 1 CMC joint right hand M18.12 Uni primary osteoarthritis 1 CMC joint left hand M19.041 Primary osteoarthritis right hand M19.042 Primary osteoarthritis left hand M19.049 Primary osteoarthritis unspecified hand |
| 714.0 Rheumatoid Arthritis | M05.40 Rheumatoid myopathy with RA unspecified site M05.41 [1,2,9] Rheumatoid myopathy with RA, shoulder M05.42 [1,2,9] Rheumatoid myopathy with RA, elbow M05.43 [1,2,9] Rheumatoid myopathy with RA, wrist M05.44 [1,2,9] Rheumatoid myopathy with RA, hand M05.45 [1,2,9] Rheumatoid myopathy with RA, hip M05.46 [1,2,9] Rheumatoid myopathy with RA, knee M05.47 [1,2,9] Rheumatoid myopathy with RA, ankle and foot 6th character meaning for codes indicated [1-right, 2-left,9-unspecified] |
It is vital for hospitals and healthcare providers to understand that the transition from ICD-9 to ICD-10 doesn't affect coding only; it involves physician reporting, billing, information technology, and revenue management.
The Musculoskeletal System in ICD-10
The musculoskeletal system is found within Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99). This system comprises of the muscular and skeletal system.
There are several changes and expansion to the musculoskeletal code system in ICD-10. Most codes in this section require additional documentation that is required to correctly code site and laterality to the highest level of specificity. Which include:
- documentation of site and laterality
- more specific information for fractures and injuries
- identification of episode of care
- additional coding instructions surrounding osteoporosis
- reorganization of codes
In ICD-10 there is greater detail to identify and report a diagnosis more appropriately. Some categories and subcategories in the musculoskeletal system (Chapter 13) require the use of seventh character extension – for example, 274.03 Chronic gouty arthropathy with tophus will translate to:
- M1a.00x1 Idiopathic chronic gout unspecified site with tophus tophi
- M1a.08x1 Idiopathic chronic gout vertebrae with tophus tophi
Implementing ICD-10
The first steps that a practice should take are assessing the impact on the practice including a system inventory. Switching to ICD-10-CM will affect the practice management system and electronic health record and/or any other billing systems.
Physician practices should not have to implement new technology to use ICD-10-CM, however new encoding software may be needed to meet the requirements of the new code set to improve accuracy of coding.
Early preparation is vital to survival in rheumatology practices. Using a phased approach with a preparation checklist has proven to be the key to success in countries where ICD-10 is currently in use as it allows for resource allocation over a number of years, rather than all at once. Listed below are key areas that should be taken into consideration:
- organize an implementation effort
- develop a communication plan
- conduct an impact analysis
- estimate a budget cost analysis
- contact system vendors
- education and training for staff
