Articles
of Interest
Article Detail
by John Nelson, MD, MHM
Article Date: Dec/2013
Get Ready for Transition to
ICD-10 Medical Coding
The
International Classification of Diseases' new diagnosis codes and how
hospitalists can prepare to use them
ICD-10 Basics and Trivia
The World
Health Organization issued the ICD-10 in 1994, and it is already in use in many
countries. Like some other countries, the U.S. made modifications to the WHO’s
original code set, so we refer to ICD-10-CM (Clinical Modification), which
contains diagnosis codes. The National Center for Health Statistics, a
department of the CDC, is responsible for these modifications.
The WHO version
of ICD-10 doesn’t have any procedure codes, so CMS developed ICD-10-PCS
(Procedure Coding System) to report procedures, such as surgeries, done in U.S.
hospitals. Most hospitalists won’t use these procedure codes often.
Table 1. Comparing the
diagnosis code sets
Table 1 (left)
compares ICD-10-CM to ICD-9-CM. Most of the additional codes in the new version
simply add information regarding whether the diagnosis is on the left or right
of the body, acute or chronic, or an initial or subsequent visit for the
condition. But the standard structure for each code had to be modified
significantly to capture this additional information. Some highlights of the
seven-character code structure are:
- Characters
1–3: category; first digit always a letter, second digit always a number,
all other digits can be either; not case sensitive;
- Characters
4–6: etiology, anatomic site, severity, or other clinical detail; for
example, 1=right, 2=left, 3-bilateral, and 0 or 9=unspecified; and
- Character
7: extension (i.e., A=initial encounter, D=subsequent encounter,
S=sequelae).
- A
placeholder “x” is used as needed to fill in empty characters to ensure
that the seventh character stays in the seventh position. For example,
T79.1xxA equates to “fat embolism, initial encounter.” (Note that the
“dummy” characters could create problems for some IT systems.)
An example of
more information contained in additional characters:
- S52=fracture
of forearm.
- S52.5=fracture
of lower end of radius.
- S52.52=torus
fracture of lower end of radius.
- S52.521=torus
fracture of lower end of right radius.
- S52.521A=torus
fracture of lower end of right radius, initial encounter for closed
fracture.
Compared to its
predecessor, ICD-10 expands use of combination codes. These are single codes
that can be used to classify either two diagnoses, a diagnosis with an
associated secondary process, or a diagnosis with an associated complication.
For example, rather than reporting acute cor pulmonale and septic pulmonary
embolism separately, ICD-10 allows use of the code I26.01: septic pulmonary
embolism with acute cor pulmonale.
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