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ICD 10 Basics

The document provides an overview of ICD-10, including what it is, the differences between ICD-10-CM and ICD-10-PCS, and the implementation date of October 1, 2014. ICD-10-CM contains over 68,000 diagnosis codes, requiring greater specificity around issues like laterality and stages of healing. ICD-10-PCS contains over 72,000 procedure codes expressed in a 7-character format designating things like body system, root operation, and approach. The transition to ICD-10 aims to improve accuracy, quality, and international alignment for coding health services and procedures.

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461 views

ICD 10 Basics

The document provides an overview of ICD-10, including what it is, the differences between ICD-10-CM and ICD-10-PCS, and the implementation date of October 1, 2014. ICD-10-CM contains over 68,000 diagnosis codes, requiring greater specificity around issues like laterality and stages of healing. ICD-10-PCS contains over 72,000 procedure codes expressed in a 7-character format designating things like body system, root operation, and approach. The transition to ICD-10 aims to improve accuracy, quality, and international alignment for coding health services and procedures.

Uploaded by

svuhari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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ICD-10 BASICS

September, 2013

What is ICD-10?
ICD-10 stands for International Classification of Diseases, 10th Revision This coding system is published by the World Health Organization (WHO) The coding system is used as a tool to describe the clinical picture of the patient and for billing purposes. All industrialized countries in the world are already using ICD-10, such as Canada, Brazil, UK, France, Ireland, China

ICD-10 CM vs PCS?
ICD-10-CM: International Classification of Diseases, 10th Revision, Clinical Modifications this is the diagnotic portion of the coding system published by the United States Government (customized for the USA). ICD-10-PCS: International Classification of Disease, 10th Revison, Procedure Classification System, has been developed to capture procedures, this was funded by the U.S. Centers for Medicare and Medicaid Services.

ICD-10 Implementation
October 1, 2014, is the compliance date for implementation of ICD-10-CM (diagnoses) and ICD-10-PCS (procedures) No more delays ICD-10-CM (diagnoses) will be used by all providers in every health care setting ICD-10-PCS (procedures) will be used only for hospital claims for inpatient hospital procedures ICD-10-PCS will not be used on physician claims, even those for inpatient visits

When to use ICD-10


If the date of service is before 10/1/2014, ICD-9 will be used Dates of service On or After 10/1/2014, use ICD-10

Basic Coding Differences


ICD-9 ICD-9 CM has 14,025 3-5-character alphanumeric diagnosis codes with 855 code categories. ICD-9 PCS has 3,824 3-4character numeric procedure codes ICD-10 ICD-10 CM has 68,000+ 37-character alphanumeric diagnosis codes with 2,000+ code categories. ICD-10 PCS has 72,000+ 7character alphanumeric procedure codes.

ICD-10 CM Format

Differences
Going from 14,000 codes to over 68,000 CM (diagnostic) codes:
Requires greater specificity Laterality (right or left designation) Stages of healing Trimesters in pregnancy

ICD-10 PCS (procedure) Code Structure

Character 1 Section

Character 2 Body System

Character 3 Root Operation

Character 4 Body Part

Character 5 Approach

Character 6 Device

Character 7 Qualifier

Medical Surgical PCS


Valid code contains seven characters Each character has a specific meaning Character meanings change by Sections Character values may change by root operation

Character 1 Section

Character 2 Body System

Character 3 Root Operation

Character 4 Body Part

Character 5 Approach

Character 6 Device

Character 7 Qualifier

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Sections of ICD-10-PCS First Character


Sections identify the general type of procedure
Sections of ICD-10-PCS 0 Medical / Surgical 1 Obstetric 2 Placement 3 Administration 4 Measurement & Monitoring 5 Extracorporeal Assistance & Performance 6 Extracorporeal Therapies 7 Osteopathic 8 Other Procedures 9 Chiropractic B Imaging C Nuclear Medicine D Radiation Oncology F Physical Rehabilitation & Diagnostic Audiology G Mental Health H Substance Abuse Treatment

Character 1 Section

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Second Character
Body system, general physiological system or anatomical region involved
29 body systems 3 general anatomical regions
Character 2 Body System

Categorization into larger grouping

Tables easier to navigate Provides information quickly about procedure All procedures with same second character are the same anatomical region or body system

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Body System versus Body Part


Body System

Body Part

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Body System Guidelines


General anatomical regions body systems
Anatomical region rather than a specific body part No information is available to code to a specific body part

Upperor Lower qualifier


Location above or below the diaphragm

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What is the Value of ICD-10?


Greater coding accuracy and specificity Higher quality information for measuring healthcare service, quality, safety and security Improved efficiencies and lower costs Reduced coding errors Alignment of the US with coding systems worldwide
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Helpful ICD-10 Web Sites


General ICD-10 Information: http://www.cms.gov/ICD10 ICD-10-PCS Coding System, Mappings, and Related Training Manual http://www.cms.gov/ICD10/13_2010_ICD10PCS.asp Transactions and Code Sets Regulations http://www.cms.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsReg ulations.asp American Health Information Management Association: http://www.ahima.org Workgroup For Electronic Data Interchange (WEDI) http://www.wedi.org

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