ICD-10 is a medical classification of diseases, diagnosis and medical procedures and is maintained by the World Health Organization (WHO). ICD-10 system was created because the current system being used in the United States has become outdated and the room to expand for new diagnosis, diseases and procedures is limited. Also the current system of ICD-9 codes does not provide the necessary details for a patient’s medical conditions or the procedures. ICD-9 is now over 30 years old and the language of the system has become obsolete in the fast changing environment of our current health care world. Other countries around the world have already adopted the new ICD-10 system, United States will mandate the adoption of ICD-10 system by October 1, 2013.

United States October 1, 2013 United Kingdom 1995 Australia 1998 Canada 2001 Germany 2000 Sweden 1997 France 1997

The ICD-10 consists of two parts:

• ICD-10-CM, which will consists of the diagnosis classification developed by the Centers of Disease Control (CDC). The new system will use a 3-7 alpha-numeric digits for coding, whereas the ICD-9 system uses a 3-5 digit code.
• ICD-10-PCS, which will consists of the procedure classification developed by the Centers for Medicare and Medicaid Services (CMS) for use in the inpatient hospital only. The new system will use a 7 digit alpha-numeric code system whereas the ICD-9 system uses a 3-4 numeric system.

ICD-10 will affect diagnosis and all inpatient procedure coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not those who just use Medicare or Medicaid claims. Everyone who is covered by the HIPPA and transmits electronic claims must also switch to Version 5010 transaction standards starting on January 1, 2012. The change in ICD-10 does not affect the CPT coding structure for outpatient procedures.

KEY TIMELINE FOR COMPLIANCE

• JANUARY 1, 2012

1. I. All electronic claims must use version 5010 for submission.
2. II. Version 4010 will be no longer accepted.

• OCTOBER 1, 2013

1. I. All claims for reimbursements must use ICD-10 standards and codes on all services provided on or after this date for all medical diagnosis and inpatient procedures.
2. II. CPT codes will continue to be used for outpatient procedures and services.

COMPARISON BETWEEN ICD-9 AND ICD-10

The diagnosis code set is changing from ICD-9-CM to ICD-10-CM. The ICD-10-CM codes can be up to 7 positions, the ICD-9 codes were up to 5 positions. The “10” codes contain both letters and numbers in all positions, the “9” codes had only the first position with letters and numbers, the rest were only numbers. There will be over 68,000 diagnosis codes to deal with in ICD-10. ICD-9 had around 13,000. More importantly, ICD-10 codes provide much greater specificity in the diagnoses.

ICD-10-CM/PCS:

• Incorporates much greater specificity and clinical information.
• Includes updated medical terminology and classification of diseases.
• Provides codes to allow comparison of mortality and morbidity data
• Provides better data for analytics to improve overall public health and health care system

Below are examples that show where ICD-10-CM/PCS codes are more precise and provide better information.

ICD-9-CM

Mechanical complication of other vascular device, implant and graft

• I. 1 code (996.1)

ICD-10-CM

Mechanical complication of other vascular grafts

156 codes, including:

1. 1. T82.310 - Breakdown (mechanical) of aortic (bifurcation) graft (replacement)
2. 2. T82.311 - Breakdown (mechanical) of carotid arterial graft (bypass)
3. 3. T82.312 - Breakdown (mechanical) of femoral arterial graft (bypass)
4. 4. T82.318 - Breakdown (mechanical) of other vascular grafts
5. 5. T82.319 - Breakdown (mechanical) of unspecified vascular grafts
6. 6. T82.320 - Displacement of aortic (bifurcation) graft (replacement)
7. 7. T82.321 - Displacement of carotid arterial graft (bypass)
8. 8. T82.322 - Displacement of femoral arterial graft (bypass)
9. 9. T82.328- Displacement of other vascular grafts

ICD-9-CM

Pressure ulcer codes

9 location codes (707.00 – 707.09)

ICD-10-CM

Pressure ulcer codes

125 codes

Show more specific location as well as depth, including

1. 1. L89.131-Pressure ulcer of right lower back, stage I
2. 2. L89.132-Pressure ulcer of right lower back, stage II
3. 3. L89.133-Pressure ulcer of right lower back, stage III
4. 4. L89.134-Pressure ulcer of right lower back, stage IV
5. 5. L89.139-Pressure ulcer of right lower back, unspecified stage
6. 6. L89.141-Pressure ulcer of left lower back, stage I
7. 7. L89.142-Pressure ulcer of left lower back, stage II
8. 8. L89.143-Pressure ulcer of left lower back, stage III
9. 9. L89.144-Pressure ulcer of left lower back, stage IV
10. 10. L89.149 - Pressure ulcer of left lower back, unspecified stage
11. 11. L89.151-Pressure ulcer of sacral region, stage I
12. 12. L89.152-Pressure ulcer of sacral region, stage II

ICD-9-CM

Angioplasty

1 code (39.50)

ICD-10-PCS

Angioplasty codes

854 codes

Specifying body part, approach, and device

1. 1. 047K04Z –Dilation of right femoral artery with drug-eluting intraluminal device, open approach
2. 2. 047K0DZ –Dilation of right femoral artery with intraluminal device, open approach
3. 3. 047K0ZZ –Dilation of right femoral artery, open approach
4. 4. 047K34Z –Dilation of right femoral artery with drug-eluting intraluminal device, percutaneous approach
5. 5. 047K3DZ –Dilation of right femoral artery with intraluminal device, percutaneous approach