ICD-10 Frequently Asked Questions
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.
What are the advantages of ICD-10?
ICD-10-CM incorporates much greater clinical detail and specificity than ICD-9-CM. Terminology and disease classification are updated to be consistent with current clinical practice. The modern classification system will provide much better data needed for:
- Measuring the quality, safety, and efficacy of care;
- Reducing the need for attachments to explain the patient's condition;
- Designing payment systems and processing claims for reimbursement;
- Conducting research, epidemiological studies, and clinical trials;
- Setting health policy;
- Operational and strategic planning;
- Designing health care delivery systems;
- Monitoring resource use;
- Improving clinical, financial, and administrative performance;
- Preventing and detecting health care fraud and abuse; and
- Tracking public health and risks.
Non-specific codes are still available for use when medical record documentation does not support a more specific code.
When will ICD-10-CM and ICD-10-PCS be implemented?
CMS has announced that the implementation date will be October 1, 2014. No delays will be allowed.
Why is the United States moving to ICD-10-CM?
ICD-9-CM has several problems. Foremost, there is not adequate space to add additional codes. 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?How is the transition to ICD-10 any different from the ICD-9 annual coding changes?
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. However, ICD-10 is not a modification of ICD-9. Literally every code in ICD-9 is replaced by one or more new values in ICD-10.
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
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.
Who is affected by ICD-10?
All health care providers, all health plans and business associates of those provider and plans that use ICD-9 codes must be compliant and transition from ICD-9 to ICD-10, effective October 1, 2014. This means that NHRMC, NHPG, Home Health, and Pender must all be compliant by October 1, 2014.
Where can I find additional information about ICD-10?
Additional information about ICD-10 can be found through the following websites: