Diagnostic Coding - ICD-10-CM Latest Version Graded A+

Diagnostic Coding - ICD-10-CM Latest Version Graded A+ ICD-10-CM HIPAA-mandated diagnosis code set under the HIPAA Electronic Health Care Transactions and Code Sets standard starting on October 1, 2014. Stands for International Classification of Diseases (ICD), Tenth Revision, Clinical Modification (CM). The ICD-10 lists diseases and codes according to a system copyrighted by the World Health Organization (WHO) of the United Nations. ICD has been revised a number of times since the coding system was developed more than one hundred years ago. ICD-10-CM Usage Used to code and classify morbidity data from patient medical records, physicians' offices, and surveys conducted by the National Center for Health Statistics. Codes in ICD-10-CM describe conditions and illnesses more precisely than does the WHOs ICD-10 because the codes are intended to provide a more complete picture of patients' conditions. ICD-10-CM Code Makeup An ICD-10-CM diagnosis code has between 3 and 7 alphanumeric characters. The system is built on categories for diseases, injuries, and symptoms. A category has 3 characters. Most categories have subcategories of either four-character or five- character codes. Valid codes themselves are either three, four, five, six, or seven characters in length, depending on the number of subcategories provided. This variable structure enables coders to assign the most specific diagnosis that is documented in the patient medical record. When they are available for assignment in the code set, sixth and seventh characters are not optional; they must be used. The Centers for Medicare and Medicaid Services (CMS) rules state that a claim will be rejected when the most specific code available is not used. NOTE: Keep in mind that the coder can only code what is documented and cannot add to any statement in the medical record. Only the physician or health care provider can add to the statement in the medical record to clarify for coding purposes. ICD-10-CM Updates The National Center for Health Statistics (NCHS) and CMS release ICD-10-CM updates called addenda. It can be anticipated that many, many changes will be made during its first years of use following October 1, 2014. The major new, invalid, and revised codes are posted on the appropriate websites, such as the NCHS and CMS websites. New codes must be used as of the date they go into effect, and invalid (deleted) codes must NOT be used. The U.S. Government Printing Office (GPO) publishes the official ICD-10-CM on the Internet and in CD-ROM format every year. Various commercial publishers include the updated codes in annual coding books that are printed soon after the updates are released. The current reference must always be in use for the date of service of the encounter being coded. ICD-10-CM Advantages There are many more categories for disease and other health-related conditions and much greater flexibility for adding new codes in the future. ICD-10-CM is a larger code set, having about 69,000 codes versus ICD-9-CM's approximately 13,000 codes. ICD-10-CM also offers a higher level of specificity and additional characters and extensions for expanded detail. There are also many more codes that combine etiology (cause) and manifestations, poisoning and external cause, or diagnosis and symptoms. Differences and Similarities Between ICD-9 and ICD-10 ICD-10 contains 21 chapters versus ICD-9's 17 chapters and two supplemental classifications, V codes and E codes, and there are differences in the order of chapters. Additionally, ICD-10-CM codes are alphanumeric and have five, six, or seven characters, whereas ICD-9-CM codes have three to five characters. There are two major similarities between the code sets: The two major sections of the ICD-9-CM and the ICD-10-CM code sets are the Alphabetic Index and the Tabular List. General Equivalence Mappings (GEMs) Reference tables of related ICD-10-CM and ICD-9- CM codes. Coders may be called upon to research an ICD-9-CM code. Perhaps an old claim resurfaces, or an audit forces a review of pre-2014 codes that were reported. Workers' Compensation (WC) claims may also specify a non-ICD-10-CM code set, because WC is NOT regulated by HIPAA law and therefore is not required to use ICD-10-CM. The federal government has prepared GEMs which may be helpful in these types of situations. Both files of equivalent codes and a conversion tool may be located via an Internet search. Particularly useful is the translator tool located on the American