ICD 10 ICD 9. 14, 000 codes No laterality Limited severity parameters No placeholders 3-5 digits
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1 ICD 10 Conversion 1
2 Why Change? ICD 9 14, 000 codes No laterality Limited severity parameters No placeholders 3-5 digits ICD 10 69,000+ codes Indicates Rt or Lt Extensive severity parameters X is a placeholder 3-7 digits alpha or numeric < numeric > alpha numeric < alpha or numeric > 2
3 ICD 10 Two Parts ICD 10 CM Diagnostic codes ICD 10 PCS Inpatient codes 3
4 ICD 9 Categories Infectious And Parasitic Diseases Neoplasms Endocrine, Nutritional And Metabolic Diseases, And Immunity Disorders Diseases Of The Blood And Blood-Forming Organs Mental Disorders Diseases Of The Nervous System And Sense Organs Diseases Of The Circulatory System Diseases Of The Respiratory System Diseases Of The Digestive System Diseases Of The Genitourinary System Complications Of Pregnancy, Childbirth, And The Puerperium Diseases Of The Skin And Subcutaneous Tissue Diseases Of The Musculoskeletal System And Connective Tissue Congenital Anomalies Certain Conditions Originating In The Perinatal Period Symptoms, Signs, And Ill-Defined Conditions Injury And Poisoning V01-V91 Supplementary Classification Of Factors Influencing services E000-E999 Supplementary Classification Of External Causes Of Injury And Poisoning 4
5 ICD 10 Categories A00-B99 Certain infectious and parasitic diseases C00-D49 Neoplasms D50-D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune system E00-E89 Endocrine, nutritional and metabolic diseases F01-F99 Mental, Behavioral and Neurodevelopmental disorders G00-G99 Diseases of the nervous system H00-H59 Diseases of the eye and adnexa H60-H95 Diseases of the ear and mastoid process I00-I99 Diseases of the circulatory system J00-J99 Diseases of the respiratory system K00-K95 Diseases of the digestive system L00-L99 Diseases of the skin and subcutaneous tissue M00-M99 Diseases of the musculoskeletal system and connective tissue N00-N99 Diseases of the genitourinary system O00-O9A Pregnancy, childbirth and the puerperium P00-P96 Certain conditions originating in the perinatal period Q00-Q99 Congenital malformations, deformations and chromosomal abnormalities R00-R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified S00-T88 Injury, poisoning and certain other consequences of external causes V00-Y99 External causes of morbidity Z00-Z99 Factors influencing health status and contact with health services 5
6 Reclassification of Codes Infectious And Parasitic Diseases Neoplasms Endocrine, Nutritional And Metabolic Diseases, And Immunity Disorders Diseases Of The Blood And Blood-Forming Organs Mental Disorders Diseases Of The Nervous System And Sense Organs Diseases Of The Circulatory System Diseases Of The Respiratory System Diseases Of The Digestive System Diseases Of The Genitourinary System Complications Of Pregnancy, Childbirth, And The Puerperium Diseases Of The Skin And Subcutaneous Tissue Diseases Of The Musculoskeletal System And Connective Tissue Congenital Anomalies Certain Conditions Originating In The Perinatal Period Symptoms, Signs, And Ill-Defined Conditions Injury And Poisoning V01-V91 Supplementary Classification Of Factors Influencing Health Status And Contact With Health Services E000-E999 Supplementary Classification Of External Causes Of Injury And Poisoning A00-B99 Certain infectious and parasitic diseases C00-D49 Neoplasms D50-D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism E00-E89 Endocrine, nutritional and metabolic diseases F01-F99 Mental, Behavioral and Neurodevelopmental disorders G00-G99 Diseases of the nervous system H00-H59 Diseases of the eye and adnexa H60-H95 Diseases of the ear and mastoid process I00-I99 Diseases of the circulatory system J00-J99 Diseases of the respiratory system K00-K95 Diseases of the digestive system L00-L99 Diseases of the skin and subcutaneous tissue M00-M99 Diseases of the musculoskeletal system and connective tissue N00-N99 Diseases of the genitourinary system O00-O9A Pregnancy, childbirth and the puerperium P00-P96 Certain conditions originating in the perinatal period Q00-Q99 Congenital malformations, deformations and chromosomal abnormalities R00-R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified S00-T88 Injury, poisoning and certain other consequences of external causes V00-Y99 External causes of morbidity Z00-Z99 Factors influencing health status and contact with health services 6
7 Code Structure Category This is made up of the first three characters Subcategory This is made up of the 4 th and/or 5 th characters S A Code A code is anything that has no further subdivision ie, a category or subcategory can be a code if not further subdivided 7
8 ICD 10- What does it tell you? First 3 positions give the heading within a category Next 3 specify etiology/site/severity/etc 7 th position can note which encounter for certain condition or information on fracture or injury S A S42 - indicates fracture of shoulder or upper arm.2 - indicates it is the upper end of the humerus 6 indicates lesser tuberosity of the humerus 5 - indicates it is nondisplaced and the left humerus A indicates this is the initial encounter for care of this diagnosis The comparable ICD 9 code is other closed fracture upper end of humerus 8
9 The Placeholder X A code that requires a 7 th character, but does not have 6 characters, will use X s as placeholders for those characters. Remember the 7 th character s place denotes certain information (not all codes require a 7 th character) Initial or subsequent encounter, sequela Type of fracture, healing status, union or malunion, etc. 9
10 The Placeholder X EX: The 7 th character denotes what type of encounter (initial or subsequent) or fracture information T33.02 is the code for Superficial frostbite of the nose. However it requires a 7 th character to identify initial or subsequent encounter Therefore the X is used as a placeholder T33.02XA Superficial frostbite of the nose, initial encounter 10
11 What does this all mean for us? There are many more codes for each diagnosis than before. More specific information will be needed to find the correct, most specific code available Some codes will require additional codes to fully describe the condition 11
12 Abbreviations NEC Not Elsewhere Classified If all listed classifications do not fit NOS Not Otherwise Specified If you are unable to describe as much as other codes require 12
13 Definitions And - should be interpreted as and/or when in a code title With - should be interpreted as associated with or due to when in a code title Code also instructs that there may be two codes required to fully describe a condition 13
14 Punctuation Used An ICD 10 code that has dashes within it represents a code that is not complete. Often used to represent all codes with the common characters listed (no matter what characters would be in the dashes). EX: G80.- would be a way to indicate all the following codes: G80.1, G80.2, G80.3, G80.4, G80.8, and G80.9 In other words, all the codes within ICD 10 that begin with G80. 14
15 Instruction Notes Various notes that give the coder additional information or clues that other information is needed Includes Excludes Code first Use additional code 15
16 Instruction Notes These notes can appear anywhere in the structured code list Category Subcategory Code 16
17 Excludes Excludes 1- this means the conditions listed are excluded in that code In other words the two conditions cannot exist together ie, the congenital and acquired form of a disease EX: Q79.5 Other congenital malformations of the abdominal wall Excludes 1: umbilical hernia (K42.-) 17
18 Excludes Excludes 2- this means the conditions are not part of the condition represented by the code The patient may have both conditions at once EX: J37.1 Chronic Laryngotracheitis Excludes 2 Acute laryngotracheitis (J04.2) Acute tracheitis (J04.1) 18
19 Etiology/Manifestation Codes There are several codes in ICD 10 that describe the manifestation of an underlying disease, not the disease itself. Therefore, they are not used as a principal diagnosis and must be listed secondary to the code for the disease itself. 19
20 Etiology/Manifestation Codes Manifestation codes will generally end with in diseases classified elsewhere Those codes that don t end this way, will be flagged with a code first... notation, indicating an etiology needs coded first Some etiology categories may be listed as suggestions to code first.. 20
21 Etiology/Manifestation Codes Ex: G63 Polyneuropathy in diseases classified elsewhere This code will be flagged as a manifestation and not billable as a primary diagnosis An appropriate primary diagnosis might be: E77.9 Disorders in glycoprotein metabolism This would be the etiology of the polyneuropathy, and would be coded first 21
22 Etiology/Manifestation Codes Ex: F02.81 Dementia is diseases classified elsewhere, without behavioral disturbance This code will be flagged as a manifestation and not billable as a primary diagnosis An appropriate primary diagnosis might be: G20 Parkinson s disease This would be the etiology of the dementia, and would be coded first 22
23 Multiple Coding for Single Condition There are also single conditions that require more than one code (outside of the etiology/manifestation codes). These will be noted by a use additional code or code also notation. This signals that another code is needed and should be secondary. 23
24 Multiple Coding for Single Condition There may also be code first or code, if applicable, any causal condition first These notations may also appear under certain codes that are not specifically manifestation codes, but that may be due to an underlying cause. These codes can be used as primary diagnosis if there is no known underlying cause; If there is such a condition or cause, that condition should be listed as primary 24
25 Multiple Coding for Single Condition Ex: J13 Pneumonia due to streptococcus pneumoniae Code first - if associated with influenza J09.X1 Influenza due to identified novel influenza A virus with pneumonia J10.0- Influenza due to other identified influenza virus J11.0- Influenza due to unidentified influenza virus Code also - If abscess is associated J85.1 Abscess of lung with pneumonia 25
26 Multiple Coding for Single Condition I60-I69 Cerebral Vascular Diseases Use additional code to identify the presence of alcohol abuse and dependence (F10.-) exposure to environmental tobacco smoke (Z77.22) history of tobacco use (Z87.891) hypertension (I10-I15) occupational exposure to environmental tobacco smoke (Z57.31) tobacco dependence (F17.-) tobacco use (Z72.0) 26
27 Other examples Cardiovascular codes often have a code first for coding of risk factors or contributing conditions When coding an infection where the causative agent is a drug resistant bacteria- need to code the infection and the resistance status Respiratory diagnosis ask for additional code regarding smoke exposure Some injury codes will have code also to help identify extent of damage done by injury 27
28 ICD 10 R codes Symptoms, signs, and abnormal clinical and laboratory findings, NEC Use these codes if definitive diagnosis is not known 28
29 ICD 9 V codes ICD 9 V codes are codes considered supplementary information of factors influencing health status and contact with health services Pre participation exams, school physicals, pre-employment physicals, health maintenance exams, well child exams, etc. Other historical information or screenings Personal medical history, family history of, etc. 29
30 IDC 10 Z codes These V codes are now Z codes in ICD 10 Includes prior V code information There is greater specificity Many more codes for health system encounters Well visits, illness exposure, screening tests, chemo and radiation, etc. Can be used for follow-up and monitoring visits for conditions which have resolved. Cancers, surgical status, certain health status, etc. 30
31 ICD 9 E codes ICD 9 E codes are codes that denote the external cause of injury or death. The corresponding ICD 10 codes are the V, W, X, and Y codes We do not report these codes, so just be aware and avoid use. 31
32 However, they are entertaining W58.13 Crushed by crocodile X05 Melting of pajamas due to fire V93.83 Carbon monoxide poisoning from jet skis W88.1 Radiation exposure to gamma rays X73.2 Suicide attempt by machine gun X35 Victim of volcanic eruption Y92.59 Injury occurred at television station Y65.51 Wrong operation performed on correct patient Y65.53 Correct procedure performed on wrong side of body Y65.62 Operation performed on patient not scheduled for surgery 32
33 Looking up codes It is recommended to use the alphabetical index to look up the code term first Use additional cross references if needed to locate correct diagnosis Then use code to look up in tabular index to see if there are any coding instructions associated with the code Code to the most characters possible (the most specific code) 33
34 Resources Free website that will convert codes and allows easy code look up CM-and-GEMs.html 2016 Code Descriptions in Tabular Order [ZIP, 2MB] 2016 Code Tables and Index [ZIP, 16MB] 2016 ICD-10-CM Guidelines [PDF, 1MB] 34
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