If you are hoping there will be another delay, think again!  CMS has been clear:  there will not be any more delays!  The compliance date for implementation of ICD-10 is October 1, 2014.

ICD-10 replaces ICD-9 diagnosis code set.  ICD-10 will also be used to identify diagnosis codes across all health care settings.  Every organization covered under the Health Insurance Portability Accountability Act will be impacted and are required to make the transition.

Why make the change?  ICD-9 limits the number of new codes that can be created and many categories are already full.  ICD-9 codes lack specificity/details to streamline automation.  This lack of specificity/details limits the payers & others to analyze information, limits operations and reporting processes, and lacks specificity to process claims and reimbursement accurately. Also, ICD-9 coding is inconsistent with current medical organizations.

So, what is so great about ICD-10?  Well, ICD-10 uses current medical terminology, the codes have greater specificity and detail, reflects improved coding based on advancements in healthcare, improved measurement and reporting with decreased rejection of claims, improved data exchange and patient care by collecting more descriptive data improving payment, and the codes provide comparison and morbidity data resulting in better clinical decisions. pic











Let’s start to explore the ICD-10 world…………………

The ICD-10-CM is divided into the Alphabetic Index (an alphabetical list of terms along with their codes), as well as the Tabular List (a structured list of codes divided into chapters based on body system or condition). The Alphabetical Index consists of:

  • Index of Diseases and Injury
  • Index of External Causes of Injury
  • Table of Neoplasms
  • Table of Drugs and Chemicals

The Tabular List contains: Categories, Subcategories, Codes.  The characters for the categories, subcategories, and codes may be either a letter or a number.

  • All categories are 3 characters and one that has no further subdivision is equivalent to a code
  • Subcategories are either 4 or 5 characters
  • Codes may be 3,4,5,6, or 7 characters
    •   When reporting, only codes (not categories or subcategories) are allowed and any 7th character is required
    • 7th Character:
      • Used in certain chapters like Obstetrics, Injury, Musculoskeletal, and External Cause
      • Certain categories have applicable 7th characters; required for all codes within the category or as the notes in the Tabular List instruct
      • Must always be the 7th character in the data field
      • If a code requires a 7th character and the code is not 6 characters in length, then the “X” placeholder must be used to fill in empty character
        • 7th character describing the encounter
          • Initial encounter
          • Subsequent encounter
          • Sequela (complications or conditions that result from a condition (scar after a burn
        • Placeholder:
          • Character “X” is used in certain codes to allow for future expansion
            • When exists, the “X” must be used for the code to be considered valid
As you can see transitioning to ICD-10-CM is much different from what we are currently using.  Being prepared is a necessity.  I will continue to review ICD-10 in future blogs.  In the meantime, please begin talking within your organization about ICD-10 as well as to your billing software vendor so you know when they will be ready to test.
Gina Tomcsik
Director of Compliance
Functional Pathways


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