It is not too early to become familiar with the ICD-10 coding systems. Contexo Media is at the forefront of ICD-10 planning and is currently offering the following products to help you learn what you need to know before the mandatory implementation date.
Contexo Media and ICD10monitor.com forge a new partnership to bring you ICD-10 news and information
Understanding ICD-10-CM Episode of Care Seventh-Character Extensions
By Laui Gray, RHIT, CPC
To begin, let’s look at similarities and differences between the format and structure of ICD-9-CM and ICD-10-CM. One significant difference between ICD-9-CM and ICD-10-CM is the need to assign a seventh character (also called a seventh-character extension) to codes in certain ICD-10-CM categories. These seventh characters are found predominantly in two chapters: Chapter 19 (Injury, Poisoning and Certain Other Consequences of External Causes) and Chapter 15 (Pregnancy, Childbirth and the Puerperium). The details captured with these extra characters are not details recorded under ICD-9-CM.
Be sure to keep your eye on future updates of this new section!
Answers to Frequently Asked Questions about ICD-10
We’ve created this resource in an effort to help our customers get ahead of the 2014 ICD-10-CM mandatory implementation date for this new and complex set of codes. Here you’ll find answers and solutions to frequently asked ICD-10 related questions, as well as the latest ICD-10 news and updates. As always, it is our commitment to provide you with the best coding tools, information, and training.
How will ICD-10 impact patients?
If payers and providers do not have ICD-10 fully implemented, it will affect claims payment and while that is something one would expect payers and providers to deal with, patients may receive confusing EOBs or may end up paying for services that would have been covered had the correct codes been used or had the payer edit systems applied the correct logic.
On the other hand if payers and providers have ICD-10 fully implemented and systems are applying the correct edits, the more specific codes may improve the claims adjudication process and patients will have fewer issues with incorrectly paid claims.
ICD-10-CM requires more specific physician documentation and while one would hope that physicians currently provide complete documentation of all pertinent conditions or findings, the need for more specific documentation may have the added benefit of improving patient care.
The more specific data being collected on diseases, disorders, and other conditions due to the greater specificity of ICD-10-CM codes, will likely have a positive impact on research, disease management, and other factors affecting the quality of health care in the United States.
Solution:
The ICD-10-CM, 2012 Draft includes the entire ICD-10-CM code set, as well as ICD-10 official guidelines for coding and reporting. Our version of the ICD-10-CM draft is prepared in a manner that parallels the ICD-9-CM code book so that using it feels easy and familiar.
Will ICD-10 be updated every year? And will the effective date each year still be 10/1/XX?
Here is a detailed timeline of how the code sets will be updated. At
the September 15, 2010 ICD-9-CM and ICD-10 Coordination and
Maintenance Meeting, the updates to the ICD systems were outlined as follows:
10/1/10 Update to ICD-10-PCS
1/31/11 Update to ICD-10-CM
10/1/11 Last regular ICD-9-CM and ICD-10 updates
10/1/12 Limited updates to both ICD-9-CM and ICD-10-CM and PCS
10/1/13 Limited updates to ICD-10-CM and PCS (no ICD-9-CM updates)
10/1/14 Regular updates to ICD-10-CM and PCS will resume
Solution:
We’ve taken the unwieldy and confusing internet version and presented the data the way you have been used to seeing diagnostic codes.
The ICD-10-PCS, 2012 Draft includes the entire ICD-10-PCS code set, conventions, official guidance from CMS and the NCHS and detailed information on the structure of ICD-10-PCS.
The ICD-10-CM, 2012 Draft includes the entire ICD-10-CM code set, as well as ICD-10 official guidelines for coding and reporting. New in the 2012 draft includes features such as color coding for faster code selection, medical term definitions and detailed, full page anatomy illustrations.
For the 7th character extensions of ADS, if a patient returns for multiple visits for the same problem that is either subsequent or a sequelae, is there a limit on how many times you can use the 7th extension? Is there a time limit after which time passes it becomes a late effect?
No, there is not a limit to how many times the seventh digit of 'D' (subsequent) may be used, as long as the patient is returning for active treatment of the condition. There is not a time limit in which the condition becomes a late effect (in ICD-10-CM, it will be 'sequelae', 7th digit extension 'S'). The sequelae is used as a secondary diagnosis, with the condition coded first, which was caused by the sequelae.
Solution:
The 2012 Advanced Anatomy and Physiology for ICD-10-CM/PCS can help conquer the learning curve for ICD-10-CM/PCS. It takes the user through all of the body systems that ICD-10 uses and gives specific details about how ICD-10-CM/PCS is used to identify the appropriate diagnosis/condition. The organization of chapters by body system covers this pertinent coding information for using ICD-10-CM in a very straight-forward presentation. The material can be used in a group setting for educational purposes or as a self-education study tool. A quiz is available at the end of each section to test your knowledge of ICD-10.
Since HTN will not be specified as benign, malignant or unspecified in ICD-10, is there a code to indicate when hypertension is uncontrolled?
No, there will not be a code to identify when hypertension is uncontrolled; I10 will be the only code available unless it is complicated by heart or renal disease due to hypertension or when the hypertension is due to an underlying condition (e.g., renovascular, endocrine, or other secondary hypertension) or it is documented that it is related to pregnancy. In that case, check the Alphabetic Index to make there is not a better code that can be used with the available documentation.
Solution:
The 2012 Advanced Anatomy and Physiology for ICD-10-CM/PCS can help conquer the learning curve for ICD-10-CM/PCS. The book clarifies the anatomical and physiological documentation requirements for code capture in ICD-10-CM and ICD-10-PCS. Color anatomy illustrations, detailed review of each body system and quizzes at the end of every chapter make this a great resource to prepare for ICD-10.
What is the meaning of the alpha character in ICD-10?
In the ICD-10 code set, the alpha character has a different meaning depending on where it is placed within the code. The first alpha character in every ICD-10-CM code identifies in what chapter it is placed. For example, "A" and "B" (A00-B99) are for the "Certain Infectious Diseases" chapters and "C" and half of the "D" chapters (C00-D49) for "Neoplasms".
In the middle of the ICD-10-CM are alpha characters. Here they do not have a specific meaning; they just expand the code set to allow for more codes.
When placed at the end of a code, it usually means "episode of care". For example, A = initial encounter, B = subsequent encounter, S = sequela. Another alpha character explanation at the end of the code will identify different types of fractures and/or the episode of care of a fracture.
ICD-10-PCS is different. Each of the characters in the ICD-10-PCS system has a specific meaning. If you go through the code set, you will find that under every character (1-7), each character will mean something different depending on the placement of the character.
Solution:
Get ahead of the 2014 ICD-10-CM mandatory implementation date for this new and complex set of codes. We’ve taken the unwieldy and confusing internet version and presented the data the way you have been used to seeing diagnostic codes in these two valuable resources:
The ICD-9-CM coding system has become outdated and obsolete. The 9th revision cannot describe diagnoses accurately with the level of detail needed for the reporting purposes of our health care system. Identifying and capturing health care data is used for tracking trends, analyzing quality, comparing and evaluating outcomes from different treatment methods, and comparing statistics internationally.Many countries have already moved to ICD-10-CM, making diagnosis coding incompatible with the United States. The ICD-9-CM system is also hampered by a lack of available places left for expansion within the diagnostic categories as future updates are made.
Solution:
Prepare yourself for the change of code sets that will be coming in October of 2014 by taking our 2011 Anatomy and Terminology Essentials from an ICD-10-CM Perspective online course. This 8 hour course reviews all of the major components of human anatomy and physiology as they relate to ICD-10-CM implementation. This course has been approved for 8 CEUs by the AAPC and the American Health Information Management Association (AHIMA).
Why is ICD-10-CM better than ICD-9-CM?
The ICD-10-CM coding system provides a significantly increased amount of options for coding medical diagnoses that reflect modern medical knowledge and terminology. The increased availability of codes allows for much greater precision and specificity within the choice of diagnosis codes. ICD-10-CM also has built-in flexibility for future expansion to add new codes for medical diagnoses.
Solution:
The ICD-10-CM, 2012 Draft includes 7th character icons to help you identify the codes that require a 7th digit to ensure specificity and validity, updated tables and indices, the entire ICD-10-CM code set and ICD-10 official guidelines for coding and reporting. New in the 2012 draft includes features such as color coding for faster code selection, medical term definitions and detailed, full page anatomy illustrations.
Our version of the ICD-10-CM draft is prepared in a manner that parallels the ICD-9-CM code book so that using it feels easy and familiar.
Is the structure of ICD-10-CM much different from ICD-9-CM?
The actual coding process remains the same and there are some similarities, such as a valid code always contains at least 3 characters and a decimal is used after the third character, but there are also distinct differences: Solution:
ICD-9-CM
ICD-10-CM
up to 5 characters
up to 7 characters, with required 7th place character extension
no place holders
place holder ‘x’ used to fill empty 4th, 5th, or 6th character positions
first character is alpha (V, E) or numeric
first character is alpha, using all but the letter “U”
subsequent characters (2-5) are numeric
subsequent characters (2-7) are alpha or numeric
Solution:
Our version of the ICD-10-CM, 2012 Draft is prepared in a manner that parallels the ICD-9-CM code book so that using it feels easy and familiar.
The unparalleled resource includes 7th character icons to help you identify the codes that require a 7th digit to ensure specificity and validity, updated tables and indices, the entire ICD-10-CM code set, ICD-10 official guidelines for coding and reporting and more!
How many diagnosis codes are there in ICD-10-CM compared to ICD-9-CM?
ICD-10-CM has approximately 68,000 codes compared to 15,000 in ICD-9-CM. The 2010 update implemented around 4,000 changes to the ICD-10-CM system.
Solution:
The ICD-10-CM, 2012 Draft includes the entire ICD-10-CM code set, as well as ICD-10 official guidelines for coding and reporting. Our version of the ICD-10-CM draft is prepared in a manner that parallels the ICD-9-CM code book so that using it feels easy and familiar.
What do I need to do to get up to speed on ICD-10-CM?
Coding with ICD-10-CM requires a more advanced knowledge of anatomy and physiology as well as more detailed documentation and an understanding of what must be included in the medical record documentation to be able to assign the correct diagnosis code.The use of teaching tools like Advanced Anatomy and Physiology for ICD-10-CM/PCS can help conquer the learning curve for coding with ICD-10-CM. The book’s organization of chapters by body system covers this pertinent coding information for using ICD-10-CM in a very straight-forward presentation. The material can be used in a group setting for educational purposes or as a self-education study tool. Context Media’s version of the ICD-10-CM draft is prepared in a manner that parallels the ICD-9-CM code book so that using it feels easy and familiar.
Solution:
The 2012 Advanced Anatomy and Physiology for ICD-10-CM/PCS will help! New features in the 2012 version include more questions for ICD-10 coding, expanded PCS chapters and more. This book will give you a detailed review of each body system and clarifies the new anatomical and physiological documentation requirements.
Staff:
Lauri Gray, CPC, RHIT has worked in the health information management field for 30 years. She began her career as a health records supervisor in a multi-specialty clinic. Following that she worked in the managed care industry as a contracting and coding specialist for a major HMO. Most recently she has worked as a clinical technical editor of coding and reimbursement print and electronic products. She has also taught medical coding at the College of Eastern Utah. Areas of expertise include: ICD-10-CM, ICD-10-PCS, ICD-9-CM diagnosis and procedure coding, physician coding and reimbursement, claims adjudication processes, third-party reimbursement, RBRVS and fee schedule development. She is a member of the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA) and holds Certified Professional Coder (CPC) and Registered Health Information Technologist (RHIT) credentials.
Lori Becks, RHIA is a clinical technical editor for Contexo Media. She has 9 years of clinical editing experience within the medical coding field. Her areas of expertise include both ICD-9-CM and CPT/HCPCS coding. She has served as a coding specialist at the University of Utah Hospital and as an assistant director of health information management. Her background also includes teaching English as a second language and technical writing. Ms. Becks is an active member of the American Health Information Management Association (AHIMA) and has attended AHIMA’s Academy for ICD-10: Building Expert Trainers in Diagnosis Coding in April 2010.
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