ICD-10 Conversion Reference Sheet

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1 This information is provided by the American Academy of Professional Coders and is available at As a reminder, your office s ability to submit claims with ICD-10 codes for dates of services or dates of discharge on or after October 1 is required for these claims to be eligible for payment. Peoples Health and other health plans are only permitted to accept and pay claims for dates of service on or after October 1 if they are submitted with ICD-10 codes. As part of your preparations for the transition from ICD-9 to ICD-10, we encourage you to participate in acknowledgement testing with Medicare, to ensure you are prepared to send and receive transactions with ICD-10 codes. Overview Although the conversion from ICD-9 to ICD-10 is mandated by the U.S government s Department of Health and Human Services, there are intrinsic benefits to the change. For physicians and patients, ICD-10 expands the diagnosis coding directory, adding increased specificity and detail, which is important to gaining a better understanding of a diagnosis and determining the proper course of treatment. For payers, ICD-10 creates more accurate definitions of services rendered. Globally, ICD-10 helps facilitate the sharing of more detailed disease information, vastly enhancing epidemiology. However, this increased specificity means more complex coding. The chart below provides a comparison of the code structure for ICD-9-CM versus ICD-10-CM. Comparison of ICD-9-CM to ICD-10-CM Code Structure ICD-9-CM ICD-10-CM Length 3 to 5 digits Up to 7 digits First digit Numeric or alpha (letters E or V only) Alpha (any letter except U) Second digit Numeric Numeric All other digits Numeric Numeric or alpha

2 The chart below provides a helpful visual reference of the differences between the structures of the two code sets. ICD-9-CM Code Structure ICD-10-CM Code Structure To illustrate the enhanced specificity of ICD-10-CM codes, please review the following example. It is the ICD-10-CM code for a displaced transverse fracture of the humerus shaft in the right arm during an initial encounter visit for a closed fracture. All of this detail is described within the code. The example below indicates which parts of the code represent each component. By comparison, the corresponding ICD-9-CM code would be , which would only describe a closed fracture of the humerus shaft. The ICD-10 code provides far more information.

3 Mapping Mapping translates ICD-9 codes into ICD-10 codes (a process called forward mapping) and translates ICD-10 codes back into the ICD-9 format (called backward mapping). This section provides examples of the different levels of complexity of forward mapping. Mapping does not always result in a simple one-to-one mapping. While some ICD-9 codes map directly to an ICD-10 code, it does not always mean the codes match in detail. Many ICD-9 codes require additional information in order to correctly map to the intended ICD-10 code; this may be information such as cause, location or type of encounter, etc. One-to-One Conversion Some codes map in a simple one-to-one conversion. For example, the ICD-9-CM code (Tietze's Syndrome) maps directly to the ICD-10-CM code M94.0. Detailed Conversion Other codes require specific details to map. Example 1: Minimal Level of Detail Some ICD-diagnosis codes, like those for pregnancy and obstetrics, generate a one-tothree crosswalk, depending on the stage of the pregnancy. The ICD-9-CM code (spotting complications during pregnancy) has three ICD-10-CM code options, requiring information about the trimester.

4 Example 2: Moderate Level of Detail The ICD-9-CM code (poisoning by hormones and synthetic substitutes) has 16 corresponding ICD-10-CM codes, requiring information about both the cause of the poisoning and the type of encounter. Example 3: Maximum Level of Detail The ICD-9-CM code (other disorders of bone and cartilage, non-union of fracture) has 2,530 corresponding ICD-10-CM codes due to the degree of specificity required in ICD-10.

5 For a period of two years or more following the October 1, 2015, ICD-10 implementation date, health record systems will still need to be able to transmit and access both ICD-9 codes and ICD-10 codes as the country fully transitions to the new code set. The ability to perform dual mapping is necessary so that equivalent codes can be found for issues of disease tracking, medical necessity edits and outcomes studies, as well as for continued processing of claims for dates of service before October 1, 2015.