icd 10 basics
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September, 2013
ICD-10 BASICS
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What is ICD-10? ICD-10 stands for International Classification of Diseases,10thRevision
This coding system is published by the World HealthOrganization (WHO)
The coding system is used as a tool to describe the clinicalpicture of the patient and for billing purposes.
All industrialized countries in the world are already usingICD-10, such as Canada, Brazil, UK, France, Ireland, China
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ICD-10 CM vs PCS?
ICD-10-CM: International Classification of Diseases, 10thRevision, Clinical Modifications this is the diagnotic portionof the coding system published by the United StatesGovernment (customized for the USA).
ICD-10-PCS: International Classification of Disease, 10thRevison, Procedure Classification System, has beendeveloped to capture procedures, this was funded by the
U.S. Centers for Medicare and Medicaid Services.
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ICD-10 Implementation October 1, 2014, is the compliance date for implementation
of ICD-10-CM (diagnoses) and ICD-10-PCS (procedures)
No more delays
ICD-10-CM (diagnoses) will be used by all providers in everyhealth care setting
ICD-10-PCS (procedures) will be used only for hospital claims
for inpatient hospital procedures
ICD-10-PCS will not be used on physician claims, even those
for inpatient visits
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When to use ICD-10
If the date of service is before 10/1/2014,
ICD-9 will be used
Dates of service On or After 10/1/2014,
use ICD-10
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Basic Coding Differences
ICD-9
ICD-9 CM has 14,025
3-5-character alphanumeric
diagnosis codes with 855code categories.
ICD-9 PCS has 3,824 3-4-
character numericprocedure codes
ICD-10
ICD-10 CM has 68,000+ 3-
7-character alphanumeric
diagnosis codes with 2,000+code categories.
ICD-10 PCS has 72,000+ 7-
character alphanumericprocedure codes.
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ICD-10 CM Format
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Differences
Going from 14,000 codes to over 68,000 CM
(diagnostic) codes:
Requires greater specificity
Laterality (right or left designation)
Stages of healing
Trimesters in pregnancy
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ICD-10 PCS (procedure) Code Structure
Character 1
Device
Character 2 Character 3 Character 7Character 5Character 4
ApproachRootOperation
Character 6
Section Body System Body Part Qualifier
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Medical Surgical PCS
Valid code containsseven characters
Each character has a
specific meaning
Character meaningschange by Sections
Character values may
change by root
operation
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Character 1
Device
Character 2 Character 3 Character 7Character 5Character 4
ApproachRoot
Operation
Character 6
SectionBody
SystemBody Part Qualifier
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Sections of ICD-10-PCS
Character1
Section
First CharacterSections identify the general type of
procedure
Sections of ICD-10-PCS
0Medical / Surgical
1Obstetric
2Placement
3Administration
4Measurement & Monitoring
5Extracorporeal Assistance & Performance
6Extracorporeal Therapies
7Osteopathic
8Other Procedures
9Chiropractic
BImaging
CNuclear Medicine
DRadiation Oncology
FPhysical Rehabilitation & Diagnostic Audiology
GMental Health
HSubstance Abuse Treatment
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Second Character
Body system, general physiological system oranatomical region involved
29 body systems
3 general anatomical regions
Categorization into larger grouping
Tables easier to navigate
Provides information quickly about procedure
All procedures with same second character are thesame anatomical region or body system
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Character 2
Body
System
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Body System versus Body Part
Body System
Body Part
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Body System Guidelines
General anatomical regions body systems
Anatomical region rather than a specific body
part
No information is available to code to a specific
body part
Upperor Lower qualifier
Location above or below the diaphragm
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What is the Value of ICD-10?
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Greater coding accuracy and specificity
Higher quality information for measuring
healthcare service,
quality, safety and
security
Improved efficiencies and lower costs
Reduced coding errors
Alignment of the US with coding systems
worldwide
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Helpful ICD-10 Web Sites General ICD-10 Information: http://www.cms.gov/ICD10
ICD-10-PCS Coding System, Mappings, and Related Training Manual
http://www.cms.gov/ICD10/13_2010_ICD10PCS.asp
Transactions and Code Sets Regulations
http://www.cms.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsReg
ulations.asp
American Health Information Management Association: http://www.ahima.org
Workgroup For Electronic Data Interchange (WEDI)
http://www.wedi.org
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http://www.cms.gov/ICD10http://www.cms.gov/ICD10/13_2010_ICD10PCS.asphttp://www.cms.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asphttp://www.cms.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asphttp://www.ahima.org/http://www.wedi.org/http://www.wedi.org/http://www.wedi.org/http://www.ahima.org/http://www.ahima.org/http://www.ahima.org/http://www.cms.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asphttp://www.cms.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asphttp://www.cms.gov/ICD10/13_2010_ICD10PCS.asphttp://www.cms.gov/ICD10