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       Healthcare Reform #2--Another Major Transition
       Diversity in HIM and Health Disparities
       The Coding Circuit:  Differences in ICD 9-CM
Phone: (708) 747-4361
The Coding Circuit: Differences in ICD 9-CM, ICD 10-CM, and ICD 10-PCS Minimize
 
By Darryl C. Moore, RHIA
Certified ICD 10-CM/ICD 10-PCS Trainer
 
Unless the Mayans’ prediction of events for December 21, 2012 comes to fruition, on October 1, 2013, the end of the ICD 9-CM (Diagnostic/Procedures) coding system will conclude and the ICD 10-CM (Diagnostic) and ICD 10-PCS (Procedures) coding systems will begin anew for utilization in the United States after almost 30 plus years of ICD 9-CM coding system usage.
 
After attending AHIMA’s Academy for ICD-10 in August of this year, I received a better understanding as to why a change is needed from ICD-9 to ICD-10.  With continued discoveries in medical science, a more “specific” system is required to accommodate new and future discoveries that will accurately not only “pinpoint” the “organ” but also the specific “body” site without ambiguity as ICD 9-CM does.  
 
In examining the two diagnostic systems, the number of the diagnostic codes in ICD 9-CM totals approximately 10,000 to 13,000+ codes in comparison to ICD 10-CM’s approximately 60,000+ codes.
 
The differences in structure between the two systems are that ICD 9-CM (diagnostic) consists of sequences of three to five characters in length, where the first digit is either alpha or numeric —characters E or V only and numeric digits 2 through 5. By contrast, in ICD 10-CM, three to seven characters are utilized with the first character being an “alpha” character. All alpha letters are utilized except the letter “U”. The second and third digits are numeric; characters four through seven can be alpha or numeric.
 
Listed below are some of the new organizational features that ICD 10-CM consists of that ICD 9-CM (diagnostic) does not have:
 
  • The expansion of diabetes codes with specific individual codes that include diabetes with manifestation(s) (i.e., chronic kidney, ketoacidosis with coma, etc.)
  • An alpha character (seventh character) to identify the initial, subsequent (follow-up) and sequelae (old/late effect) for injury and external causes for care encounters 
  •  Individual codes for laterality that specifically identify left and right sides/sites of the body
 
In examining the two procedural systems, the ICD 9-CM (Procedures) system consists of approximately 3,000 to 4,000 codes in comparison to ICD10-PCS’s approximately 70,000+ codes.
 
The differences in structure between the two systems are that in ICD 9-CM Procedure coding there are three to four numeric characters with the decimal point after the second digit. The codes are ascertained from a “fixed and finite” set of codes in a list-style form. All codes are numeric; and the system follows the same structure designed for diagnostic coding.
 
In ICD 10-PCS, the codes are seven characters in length; the codes are constructed from “flexible” code component values using established tables; codes are alphanumeric and the system is specifically designed to meet the needs of “healthcare” procedure coding.
 
Some of the new organizational features that ICD 10-PCS contains that ICD 9-CM procedure coding system does not include are:
 
  • The expansion of a code is easily incorporated into the system without any impact or disruption to the system
  • Each procedure is assigned to only one code
  • The device type utilized for a procedure is identified within the assignment of the procedure code
 
While the increase in the number of codes from the ICD 9-CM system to ICD 10-CM and ICD 10-PCS is voluminous, the accuracy of physician documentation will still be a major factor in the accurate assignment of codes.
 
While a number of our colleagues have stated that the implementation of ICD 10 will prompt them to retire, I feel that ICD 10 is not something to fear but rather to embrace as it will provide a more efficient and exact code assignment as to what occurred during an encounter (with all questions removed).
 
Get ready forthe ICD 10 locomotive train because it is rapidly approaching the station!

 
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