ICD-10-CM: Benefits and Enhancement to ICD-9-CM

ICD10_BenefitsOn or after October 1, 2013, the current diagnosis code sets (ICD-9-CM) will be replaced with the new code – ICD-10-CM.  This article discusses the benefits of ICD-10-CM, similarities and differences between the two coding systems, and new features and and additional changes that can be found in ICD-10-CM.

Benefits of ICD-10-CM:

ICD-9-CM is 30 years old, has outdated and obsolete terminology that produce inaccurate and limited data, and is inconsistent with the current medical practice. ICD-10-CM incorporates much greater clinical detail and specificity than ICD-9-CM.  ICD-10-CM:

  • Incorporates much greater specificity and clinical information, which results in:
    • Improved ability to measure health care services;
    • Increased sensitivity when refining grouping and reimbursement methodologies;
    • Enhances ability to conduct public health surveillance; and
    • Decreased need to include supporting documentation with claims;
  • Includes updated medical terminology that is consistent with the current medical practice;
  • Provides codes to allow comparison of mortality and morbidity data; and
  • Provides better data for:
    • Measuring care furnished to patients;
    • Designing payment systems;
    • Processing claims;
    • Making clinical decisions;
    • Tracking public health;
    • Identifying fraud and abuse; and
    • Conducting research.

New Features Found in ICD-10-CM:

  • Laterality (left, right, bilateral)
  • Combination codes for certain conditions and common associated symptoms and manifestations
  • Combination codes for poisonings and their associated external cause
  • Obstetric codes identify trimester instead of episode of care
  • Character “x” is used as a 5th character placeholder in certain 6 character codes to allow for future expansion and to fill in other empty characters when a code that is less than 6 characters in length requires a 7th character
  • Two types of Excludes notes
    • Excludes 1 – indicates that the code excluded should never be used with the code where the note is located
    • Excludes 2 – indicates that the patient may have combination of conditions and both codes could be used
  • Inclusion of clinical concepts that do not exists in ICD-9-CM e.g. underdosing, blood type, blood alcohol level
  • Expansion of codes e.g. injuries, diabetes, substance abuse, postoperative complications
  • Codes for postoperative complications have been expanded and a distinctions made between intraoperative complications and postprocedural disorders

Additional Changes Found in ICD-10-CM:

  • Injuries are grouped by anatomical site rather than by type of injury;
  • Codes and categories have reorganize;
  • New code definitions; and
  • The current “V” codes (Factors influencing health status and contact with health services) and “E” codes (External causes of injury and poisoning) are incorporated into the main classification rather than separated into supplemental sections.

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