ICD-9 and ICD-10 Clinical Concept Examples Version 1.0
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1 Version 1.0 Page 1 of 8 December 11, 2011
2 Revision History Date Rev Author Description M M/DD/Y Y 1 Page 2 of 8 December 11, 2011
3 Table of Contents 1. Background Purpose Clinical Concepts Diabetes Example Fracture of the Radius Example... 6 List of Tables Table 1: Diabetes Code Clinical Related Concepts... 4 Table 2: Fracture + Radius Related Concepts... 7 Page 3 of 8 December 11, 2011
4 1. Background ICD-10 offers a significant improvement in the ability to define complexity, risk, severity, comorbidities, complications and a number of other key factors related to patient health conditions. Leveraging the advantages of ICD-10 requires an understanding of some of these key clinical concepts and how the codes are used in ICD-10 codes in different clinical subject areas. Understanding the difference in how these concepts are handled in ICD-10 vs. ICD-9 is important to understand challenges in the transition process and educate business analysts with best practices around managing information migration. 2. Purpose The purpose of the artifact is to provide examples of concepts of ICD-10 that help to identify risk and severity that are not in ICD-9 today. 3. Clinical Concepts The following examples demonstrate the type of analysis that will be important during this transition period as well as the opportunities to leverage the advantages of ICD-10. These examples demonstrate significant new parameters available in ICD-10 that offer the ability to identify key factors: risk, severity, complications, etc Diabetes Example The diabetes example contains an analysis of ICD-9 and ICD-10 codes that include the concept of Diabetes within the code definitions. The analysis generated the following statistics 1 : The number of codes that include the concept of Diabetes in ICD-10 = 276 The number of codes that include the concept of Diabetes in ICD-9 = 83 The number of unique concepts in Diabetes related ICD-10 codes = 62 Table 1 illustrates the analysis of ICD-10 and ICD-9 including the following: Clinical Concepts included only in the ICD-10 codes Clinical Concepts which exist in both ICD-9 and ICD-10 Clinical Concepts which exist only in ICD-9 Table 1: Diabetes Code Clinical Related Concepts Diabetes Code Concepts Diabetes Type Only I C D-10 Both I C D-9 and 10 Only I C D-9 Underlying condition Type 1 diabetes Secondary Drug or chemical Type 2 diabetes induced 1 This analysis includes only codes that specifically reference Diabetes. There are additional ICD-9 codes that can be added to supplement missing concepts in some cases, however the rules of use are variable and they are left out for purposes of this analysis. Page 4 of 8 December 11, 2011
5 Diabetes Code Concepts Pregnancy Neurologic complications Lab Findings Renal complications Ophthalmologic Only I C D-10 Both I C D-9 and 10 Only I C D-9 Pre-existing Gestational Underdosing of insulin and oral hypoglycemic First trimester Second trimester Third trimester Childbirth Puerperium Neuropathy Mononeuropathy Autonomic (poly)neuropathy Amyotrophy Hypoglycemia Hyperglycemia Nephropathy Chronic kidney disease Poisoning by insulin and oral hypoglycemic Adverse effect of insulin and oral hypoglycemic Neurological complication Polyneuropathy Coma Ketoacidosis Hyperosmolarity Kidney complication Retinopathy Macular edema Cataract Ophthalmic complication Mild nonproliferative retinopathy Severe nonproliferative retinopathy Proliferative retinopathy Antepartum Postpartum Background retinopathy Page 5 of 8 December 11, 2011
6 Diabetes Code Concepts Vascular Skin Joint O ral Diabetic Control Encounter Other Concepts Only I C D-10 Both I C D-9 and 10 Only I C D-9 Circulatory complications Gangrene Dermatitis Foot ulcer Skin complications Foot ulcer Skin ulcer Neuropathic arthropathy Arthropathy Oral complications Periodontal disease Diet-controlled Insulin controlled Initial encounter Subsequent encounter Sequela Right Left Accidental Intentional self-harm Assault Personal history Peripheral angiopathy Family history Screening Uncontrolled Controlled 3.2. Fracture of the Radius Example The facture of the radius example analyzes all ICD-9 and ICD-10 codes that include the concept of Fracture and Radius within the code definitions. The analysis generated the following statistics: The number of codes that include the concept of Fracture + Radius in ICD-10 = 1734 Page 6 of 8 December 11, 2011
7 The number of codes that include the concept of Fracture + Radius in ICD-9 = 27 The number of unique concepts in ICD-10 codes that include the concepts of Fracture + Radius = 52 Table 2 illustrates the analysis of ICD-10 and ICD-9 including the following: Clinical Concepts included only in the ICD-10 codes Clinical Concepts which exist in both ICD-9 and ICD-10 Clinical Concepts which exist only in ICD-9 Table 2: Fracture + Radius Related Concepts Dimension Only I C D-10 Both I C D-9 and 10 Only I C D-9 Named F ractures Galleazzi s Colles Smith s Barton s Radial Styloid F racture Type Physeal fracture Open Neoplastic disease Closed Greenstick Pathological Stress Torus Orthopedic implant Bent Bone Healing Localization Encounter Displacement Normal Delayed Nonunion Malunion Styloid process Initial Subsequent Sequelae Displaced Non-displaced Shaft Lower end Upper end Head Neck Page 7 of 8 December 11, 2011
8 Dimension Only I C D-10 Both I C D-9 and 10 Only I C D-9 Classification Salter Harris 2 I Salter Harris II Salter Harris III Salter Harris IV Gustillo 3 type I or II Gustillo type IIIA, IIIB, or IIIC Laterality Left Right Bilateral Joint Involvement Intra-articular Extra-articular F racture Pattern Comminuted Oblique Segmental Spiral Transverse Other Concepts Fracture Radius Bone Trauma Musculoskeletal System Upper extremity Forearm Ulna 2 The Salter Harris classification identifies different patterns of fractures involving the growth plates in children. A Type I is very low risk and requires minimal treatment; a Type IV has a high risk and requires extensive treatment. 3 The Gustillo classification identifies increasing risk for different patterns of fractures that are exposed to the air. Page 8 of 8 December 11, 2011
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