3 ICD-10 Changes Include Specificity, Expansion, Combination

ICD-10 is almost here, with only 43 days remaining. Of paramount significance come October 1 when ICD-10 implementation swings into full gear is a keen and clear understanding of what will be different this time around.

The following is a narrowed list of selected highlights regarding key differences between ICD-9 and ICD-10 worth paying attention to within the next approximate 6 weeks.

Staying ahead of the specificity curve

ICD-10 is the requirement for a more detailed knowledge of the human body, as EHRIntelligence.com reported. More complicated codes means there are more codes associated with each type of injury, system, or diagnosis. Such a fact complicates things, to put it lightly. ICD-10 coders need to essentially learn or re-learn college-level anatomy and physiology and medical terminology.

As RevCycleIntelligence.com reported, recent graduates are achieving a high level of coding proficiency, as they are perhaps simply more prepared for ICD-10 than those who have been working in the healthcare industry for years because the former has a knowledge base that is simply more current.

Whereas ICD-9 has 13,000 codes, ICD-10 will contain 68,000 – this means there will be 19 times as many procedural codes and 5 times as many diagnosis codes. Whereas ICD-9-based codes were numeric, ICD-10-based codes are alphanumeric, which facilitates an increased level of specificity.

According to the Centers for Medicare & Medicaid Services (CMS), a more modernized classification system will provide a much more advanced data stream necessary for improving financial performance, designing payment systems, and processing reimbursement claims.

As RevCycleIntelligence.com reported, CMS recently clarified how ICD-10 codes are composed and what best defines a valid code, an invalid code, and a denied claim. ICD-10-CM uses 3-7 alpha and numeric digits and full code titles, CMS says, adding that the most significant changes between ICD-9 and ICD-10 are in organization, structure, code composition, and level of detail.

CMS notes examples of expandability

ICD-10 has a tad more wiggle room to incorporate new procedures and illnesses as they develop and evolve. “X” marks the spot come October 1, as the character “x” will be used as a fifth character placeholder within certain 6-character codes, says CMS. This will allow for much greater expansion levels and for the filling in of empty characters when a code that is less than 6 characters in length requires an additional character.

CMS lists the following examples of such: T46.1x5A – the adverse effect of calcium-channel blockers, initial encounter; T15.02xD – foreign body in cornea, left eye, subsequent encounter.

Codes that have been significantly expanded upon include areas of injuries, diabetes, substance abuse, and postoperative complications, CMS confirms. An example includes F10.182 – alcohol abuse with alcohol-induced sleep disorder. Regarding postoperative complications, worthy of note is ICD-10 includes a distinction between intraoperative complications and postprocedural disorders.

Examples of such include 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.

Indeed, as RevCycleIntelligence.com confirms, in ICD-9, many categories were limited to 3 or 4 digits. Now, there will be fifth, sixth, and even seventh characters and extensions present within ICD-10.

Combination codes ease sequencing hiccups

ICD-10 makes it possible to code multiple diagnosis within a singular code, thereby eliminating sequencing dilemmas. Examples include K57.21 – diverticulitis of the large intestine with perforation and abscess with bleeding; E11.341 – type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema; I25.110 – atherosclerotic heart disease of the native coronary artery with unstable angina pectoris.

Combination codes will also be associated with poisoning and their associated external causes. For instance, consider T42.3x2S – poisoning by barbiturates, intentional self-harm, sequela. Also, obstetric codes will identify a trimester instead of care episode, such as O26.02 – excessive weight gain in pregnancy during the second trimester.

Similarly, ICD-10 specifies laterality levels – left, right, or bilateral. For instance, C50.511 refers to the malignant neoplasm of the lower-outer quadrant of a female’s right breast.

Closing thoughts

As the healthcare industry pushes through October and beyond, it is hopeful ICD-10 will be smooth as the anticipated spike in claims denials and rejections is monitored and analyzed. As diseases – such as the Ebola outbreak – and brand new illnesses progress, protecting the health of the nation is a key healthcare – and humanist – objective. The question is now about getting there.

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Photo courtesy of: Rev Cycle Intelligence

Originally published on: Rev Cycle Intelligence