Diagnostic Coding - ICD-10-CM
Exam/69 Q’s and A’s/100% Scores
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 Association of Professional Coders (AAPC) website.
Note that confusion may result if the coder mixes up the ICD-9-CM codes
that start with the capital letter E with those in ICD-10-CM that also start with
E. There are a number of codes that are the same in both systems, but have
different meanings.
-ICD-10-CM Two Major Parts - -The first major part is the ICD-10-CM Index to
Diseases and Injuries. The major section of this part, known as the
Alphabetic Index, provides an index of the disease descriptions in the second
major part, the Tabular List. Many descriptions are listed in more than one
manner. The second major part is the ICD-10-CM Tabular List of Diseases and
Injuries. The Tabular List is made up of 21 chapters of disease descriptions
and their codes.
Exam/69 Q’s and A’s/100% Scores
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 Association of Professional Coders (AAPC) website.
Note that confusion may result if the coder mixes up the ICD-9-CM codes
that start with the capital letter E with those in ICD-10-CM that also start with
E. There are a number of codes that are the same in both systems, but have
different meanings.
-ICD-10-CM Two Major Parts - -The first major part is the ICD-10-CM Index to
Diseases and Injuries. The major section of this part, known as the
Alphabetic Index, provides an index of the disease descriptions in the second
major part, the Tabular List. Many descriptions are listed in more than one
manner. The second major part is the ICD-10-CM Tabular List of Diseases and
Injuries. The Tabular List is made up of 21 chapters of disease descriptions
and their codes.
