ICD-10-CM is Big

by Rick Lehtinen

When I was asked to come up with a succinct summary of ICD-10-CM and the upcoming transition to it, I didn’t blink. “It’s big,” I said.

That pretty much sizes it up. The ICD-10 code set is huge, over five times larger than ICD-9. The new code is so specific that it may require many doctors and staff members to refresh their knowledge of anatomy and medical terminology. For instance, a code in ICD-9 which may have described a broken forearm, in ICD-10 will require specifying which forearm, which bone in the forearm, which portion of that bone, and the nature of the break.

And the job of translation between the sets is crazy, because there is not a one-to-one mapping between any item in ICD-9 and the closest corresponding item in ICD-10. In fact, each item in ICD-9 may represent several items in ICD-10, and there are some ICD-10 items for which there is no corresponding ICD-10 entry. (Medical science has moved on since ICD-9 was put together.)

Regardless, a patient seen initially or discharged after October 1, 2013, must be coded with ICD-10, or the government will not pay. This means you. We have received an e-mail that used just two words to describe the doctor’s reaction to the transition, but it will not work.

WHO is doing this to you?

So WHO’s idea is all of this? It all started a couple of hundred years ago, when a doctor in the UK decided it would be a pretty good idea to see what people were dying of. That way, the most intimidating deaths could be prevented, or at least taxed. The resulting work was copied in the U.S., which developed its own mortality indexes.

Eventually someone figured out that it would be a good idea to track things that almost killed people, and the morbidity index was born. Since people lived and died pretty much all over the planet, an international organization eventually took up the challenge of tracking these things. The World Health Organization is today the copyright holder of the International Classification of Disease, although there has been a great deal of support provided by the U.S and U.S. companies. But the U.S. is not really in the forefront. We are still using ICD-9. Most of the rest of the world started using ICD-10 almost a decade ago. Some nations are experimenting with ICD-11.

Here is the difference that will matter the most to you in the short term.

ICD-9-CM

• ICD-9-CM has 14,025 codes. It is updated regularly, but that will cease soon as the world finishes its conversion to ICD-10.
• ICD-9 codes are 3-5 characters long, and the characters are numeric. Codes are laid in a group of three characters, followed by a group of two. A decimal point fits between the two groups.  

XXX.XX

• In the main body of the code set (chapters 1-17), all the characters are numbers.
• In the Supplemental codes (E codes and V codes) the leading character is an  E or V, and the rest are numbers.  
• The longer the code, the more specific the description of the disease.

ICD-10

• *ICD-10-CM has ICD-10-CM 68,069 codes. It is updated regularly.
• *ICD-10-CM codes are 3-7 characters each. Codes are laid out in a group of three characters, followed by a group of three more characters, followed by a placeholder of one character. A decimal point is used after the first three characters.

XXX.XXX X

• *The first character is any letter between A and Z, but not U. The remaining characters can be letters or numbers.
• *The longer the code, the more specific the description of the disease.

What’s The Matter?

Why is this the most important thing you need to know right now? Because the larger code words do not fit the existing forms and transmission systems. The HIPAA 4010 transmission standard is being replaced by HIPAA 5010 as of January 1, 2012. Documents filed after this date must use HIPPA 5010 or they will not be paid.

Here is a table that CMS provides regarding the conversion. We have marked in where the industry is in the transition right now.

Of course, there are many other differences than can be listed in this short article. In fact, to help you make the transition to ICD-10-CM we have written a book about it, called ChiroCode Complete & Easy ICD-10 Coding for Chiropractic. You can order it in the Chirocode Store.

This book is your one-stop reference for all aspects of the ICD-10-CM conversion. It includes a comprehensive list of relevant ICD-10-CM codes for Chiropractic, tools to help you translate from ICD-9-CM to ICD-10-CM, a complete guide to understanding ICD-10-CM coding, and the other aids you will need to make the transition painless. You’ll need to obtain this book NOW to avoid any interruption to your revenue stream.