- ICD-9-CM Diagnoses Codes:
Are 3–5 digits;
The first digit is alpha (E or V) or numeric (alpha characters are not case
Digits 2–5 are numeric; and
A decimal is used after the third character.
- ICD-10-CM Diagnosis Codes:
Are 3–7 digits;
Digit 1 is alpha;
Digit 2 is numeric;
Digits 3–7 are alpha or numeric (alpha characters are not case sensitive); and
A decimal is used after the third character.
NEW FEATURES IN ICD-10-cm WITH EXAMPLES
1) Laterality (Left, Right, Bilateral)
C50.511 – Malignant neoplasm of lower-outer quadrant of RIGHT female breast;
H16.013 – Central corneal ulcer, BILATERAL; and
L89.012 – Pressure ulcer of RIGHT elbow, stage II.
2) Combination Codes For Certain Conditions and Common Associated Symptoms and Manifestations
K57.21 – Diverticulitis of large intestine WITH perforation and abscess with
E11.341 – Type 2 diabetes mellitus WITH severe nonproliferative
diabetic retinopathy with macular edema; and
I25.110 – Atherosclerotic heart disease of native coronary artery WITH unstable
3) Combination Codes for Poisonings and Their Associated External Cause
T42.3x2S – Poisoning by barbiturates, intentional self-harm, sequela.
4) Obstetric Codes Identify Trimester Instead of Episode of Care
O26.02 – Excessive weight gain in pregnancy, SECOND TRIMESTER.
5) Character “x” is Used as a 5th Character Placeholder in Certain 6 Character Codes to Allow for Future Expansion and to Fill in Other Empty Characters (For Example, Character 5 and/or 6) When a Code That is Less Than 6 Characters in Length Requires a 7th Character
T46.1x5A – Adverse effect of calcium-channel blockers, initial encounter; and
T15.02xD – Foreign body in cornea, left eye, subsequent encounter.
6) Two Types of Excludes Notes
- Ø Excludes 1 – Indicates that the code excluded should never be used with the code where the note is located (do not report both codes).
Example: Q03 – Congenital hydrocephalus.
- Excludes 1: Acquired hydrocephalus (G91.-).
- Excludes 2 – Indicates that the condition excluded is not part of the condition represented by the code but a patient may have both conditions at the same time, in which case both codes may be assigned together (both codes can be reported to capture both conditions).
Example: L27.2 – Dermatitis due to ingested food. Excludes 2: Dermatitis due to
food in contact with skin (L23.6, L24.6, L25.4)
7) Inclusion of Clinical Concepts That Do Not Exist in ICD-9-CM (For Example, Underdosing, Blood Type, Blood Alcohol Level)
T45.526D – Underdosing of antithrombotic drugs, subsequent encounter;
Z67.40 – Type O blood, Rh positive; and
Y90.6 – Blood alcohol level of 120 – 199 mg/100 ml.
8) A Number of Codes Are Significantly Expanded (For Example, Injuries, Diabetes, Substance Abuse, Postoperative Complications)
E10.610 – Type 1 diabetes mellitus with diabetic neuropathic arthropathy;
F10.182 – Alcohol abuse with alcohol-induced sleep disorder; and
T82.02xA – Displacement of heart valve prosthesis, initial encounter.
9) Codes for Postoperative Complications Are Expanded and a Distinction is Made Between Intraoperative Complications and Postprocedural Disorders
D78.01 – Intraoperative hemorrhage and hematoma of spleen complicating a
procedure on the spleen; and
D78.21 – Postprocedural hemorrhage and hematoma of spleen following a
procedure on the spleen.
ICD-10 Resource List
- Contains videos for small practices, resource flyers as well as a clinical documentation video.
- Robust resources for practices of all sizes including options to purchase physician training, ICD-10 manuals
- Laminated ICD-10 crosswalk cards available for purchase ($24.95-specialty specific)
Below are suggested links you should begin using now as ICD-10 nears:
- ICD-10 Code Translator: http://www.aapc.com/ICD-10/codes/index.aspx
- CMS ICD-10 “GEMS” (General Equivalence Mappings) http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and-GEMs.html **Be sure that you are reading the Introduction to the Gems file contained within the zip files. This is imperative in understanding the structure of GEMS
- Additional GEMS “FAQ” Resource: http://www.cms.gov/Medicare/Coding/ICD10/downloads/gems-crosswalksbasicfaq.pdf
It is predicted that the ICD-10 transition will make a significant impact on cash flow due to delayed payment and claims adjudication. Although testing occurs, the industry cannot be certain that claims will process as correct and timely as they do now.
Therefore, it is our recommendation that every practice reserve at least enough money to cover everything required to keep your practice operational for 3-4 months in the event there is a disruption in cash flow due to delayed payments and/or denials.
If you would like more information about how we can tailor our services to meet your needs, please contact Lisa Kropp; Coding & Credentialing Manager at 716.348.3904 or firstname.lastname@example.org