ICD-10Sarah Enright
Provider Relations
What is ICD?• The ICD is the international standard diagnostic
classification for many health management purposes and clinical use including:– Analysis of the general health situation of population
groups– Monitoring of the incidence and prevalence of diseases
and other health problems in relation to other variables • Used to classify diseases and other health problems
recorded on many types of health and vital records.• Enables the storage and retrieval of diagnostic information
for clinical, epidemiological, and quality purposes.• Provides the basis for the compilation of national mortality
and morbidity statistics.
Who Maintains ICD-10?
• ICD-10-CM– National Center for Health Statistics (NCHS)– Centers for Disease Control and Prevention
(CDC)• ICD-10-PCS
– Centers for Medicare and Medicaid Services (CMS)
Federal Mandate
In January 2009, the Department of Health and Human Services issued a final rule requiring all HIPAA-covered entities to use ICD-10 diagnosis and procedure codes for HIPAA transactions with dates of service or dates of discharge on or after October 1, 2013.
HIPAA 5010 Compliance
Nomenclature Change
Why Transition to ICD-10?
• ICD-9 produces limited data about patients’ medical conditions and inpatient hospital procedures.
• ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice.
• The structure of ICD-9 limits the number of new codes that can be created; many ICD-9 categories are full.
Comparison ICD‐9‐CM ICD‐10‐CM
# of Characters 3‐5 Numeric
(+V and E codes)
3‐7 Alphanumeric
# of Codes ~ 13,500 ~ 68,000
Comparison ICD‐9‐CM ICD‐10‐PCS
# of Characters 3‐4 Numeric 7 Alphanumeric
# of Codes ~ 4,000 ~ 72,000
Diagnosis Codes
Procedure Codes
Structural Differences Between ICD-9 and ICD-10
Information Patterns
In general, ICD‐10 codes are more specific than ICD‐9.Certain cases exist where ICD‐9 is more specific than ICD‐10:
Method of detection eliminated in ICD‐10.Legal status and completeness of procedure eliminated in ICD‐10.
896.2 Traumatic amputation of foot
S98.011A Complete traumatic amputation of (complete or partial) bilateral
right foot at ankle level, initial encounterwithout mention of complication
S98.012A Complete traumatic amputation of left foot at ankle level, initial encounter
S98.021A Partial traumatic amputation of right foot at ankle level, initial encounter
S98.022A Partial traumatic amputation of left footat ankle level, initial encounter
ICD‐9 Code and Description
ICD‐10 Codes and Description
Differences in Specificity
Diagnosis Codes for Sprained and Strained Ankles: ICD-9-CM vs. ICD-10-CM
4 ICD‐9 Codes
845.00
Sprain and strain
of ankle, unspecified
site
845.01
Sprain and strain
of ankle, Deltoid
ligament/Internal
collateral ligament
845.02 Sprain and strain
of ankle,
Calcaneofibular
(ligament)
845.03 Sprain and strain
of ankle, Tibiofibular
(ligament) distal
72 ICD‐10 CodesS93.401A Sprain of unspecified
ligament of right ankle ‐
initial
encounterS93.401D
Sprain of unspecified
ligament of right ankle –
subsequent
encounterS93.401S
Sprain of unspecified
ligament of right ankle – sequelaS93.402A
Sprain of unspecified
ligament of left ankle ‐
initial
encounterS93.402D
Sprain of unspecified
ligament of left ankle –
subsequent
encounterS93.402S
Sprain of unspecified
ligament of left ankle –
sequelaS93.409A
Sprain of unspecified
ligament of unspecified ankle ‐
initial
encounterS93.409D
Sprain of unspecified
ligament of unspecified ankle–
subsequent encounterS93.409S
Sprain of unspecified
ligament of unspecified ankle–
sequelaS93.421a
Sprain of deltoid ligament
of right ankle ‐
initial encounterS93.421d
Sprain of deltoid ligament
of right ankle – subsequent
encounterS93.421q
Sprain of deltoid ligament
of right ankle –SequelaS93.422a
Sprain of deltoid ligament
of left ankle ‐
initial encounterS93.422d
Sprain of deltoid ligament
of left ankle –
subsequent encounterS93.422q
Sprain of deltoid ligament
of left ankle –
sequelaS93.429a
Sprain of deltoid ligament
of ankle unspecified ‐
initial
encounterS93.429d
Sprain of deltoid ligament
of unspecified ankle–
subsequent
encounterS93.429q
Sprain of deltoid ligament
of unspecified ankle–
sequelaS93.411A
Sprain of calcaneofibular
ligament of right ankle ‐
initial
encounterS93.411D
Sprain of calcaneofibular
ligament of right ankle –
subsequent
encounter
S93.411S
Sprain of calcaneofibular
ligament of right ankle – sequelaS93.412A
Sprain of calcaneofibular
ligament of left ankle ‐
initial
encounterS93.412D
Sprain of calcaneofibular
ligament of left ankle –
subsequent
encounterS93.412S
Sprain of calcaneofibular
ligament of left ankle –
sequelaS93.419A
Sprain of calcaneofibular
ligament of unspecified ankle ‐
initial
encounterS93.419D
Sprain of calcaneofibular
ligament of unspecified ankle–
subsequent encounterS93.419S
Sprain of calcaneofibular
ligament of unspecified ankleS93.431A
Sprain of tibiofibular
ligament of right ankle ‐
initial
encounterS93.431D
Sprain of tibiofibular
ligament of right ankle –
subsequent
encounterS93.431S
Sprain of tibiofibular
ligament of right ankle – sequelaS93.432A
Sprain of tibiofibular
ligament of left ankle ‐
initial
encounterS93.432D
Sprain of tibiofibular
ligament of left ankle –
subsequent
encounterS93.432S
Sprain of tibiofibular
ligament of left ankle –
sequelaS93.439A
Sprain of tibiofibular
ligament of unspecified ankle ‐
initial
encounterS93.439D
Sprain of tibiofibular
ligament of unspecified ankle–
subsequent encounterS93.439S
Sprain of tibiofibular
ligament of unspecified ankle–
sequelaS93.491A
Sprain of other ligament of
right ankle (Internal
collateral/talofibular) initial encounterS93.491D
Sprain of other ligament of
right ankle (Internal
collateral/talofibular) subsequent
encounterS93.491S
Sprain of other ligament of
right ankle (Internal
collateral/talofibular) sequela
S93.492A
Sprain of other ligament of
left ankle, initial encounterS93.492D
Sprain of other ligament of
left ankle subsequent encounterS93.492S
Sprain of other ligament of
left ankle sequelaS93.499A
Sprain of other ligament of
unspecified ankle initial encounterS93.499D
Sprain of other ligament of
unspecified ankle subs encounterS93.499S
Sprain of other ligament of
unspecified ankle (Internal
collateral/talofibular) sequelaS96.211A
Strain of intrinsic muscle and
tendon at right ankle and foot level
initial encounterS96.211D
Strain of intrinsic muscle and
tendon at right ankle and foot level
subsequent encounterS96.211S
Strain of intrinsic muscle and
tendon at right ankle and foot level
sequelaS96.212A
Strain of intrinsic muscle and
tendon at left ankle and foot level
initial encounterS96.212DStrain of intrinsic muscle and
tendon at left ankle and foot level
subsequent encounterS96.212S
Strain of intrinsic muscle and
tendon at left ankle and foot level
sequelaS96.219A
Strain of intrinsic muscle and
tendon at ankle and foot level,
unspecified side initial encounterS96.219D
Strain of intrinsic muscle and
tendon at ankle and foot level,
unspecified side subs encounterS96.219S
Strain of intrinsic muscle and
tendon at ankle and foot level,
unspecified sideS96.811A
Strain of other muscles and
tendons at right ankle and foot level
initial encounter S96.811D
Strain of other muscles and
tendons at right ankle and foot level
subsequent encounter
S96.811S
Strain of other muscles and
tendons at right ankle and foot level
sequelaS96.812A
Strain of other muscles and
tendons at left ankle and foot level
initial encounterS96.812D
Strain of other muscles and
tendons at left ankle and foot level
subsequent encounterS96.812S
Strain of other muscles and
tendons at left ankle and foot level
sequelaS96.819A
Strain of other muscles and
tendons at ankle and foot level,
unspecified side initial encounterS96.819D
Strain of other muscles and
tendons at ankle and foot level,
unspecified side subs encounterS96.819S
Strain of other muscles and
tendons at ankle and foot level,
unspecified side sequelaS96.911A
Strain of unspecified muscle
and tendon at right ankle and foot
level initial encounterS96.911D
Strain of unspecified muscle
and tendon at right ankle and foot
level subs encounterS96.911S
Strain of unspecified muscle
and tendon at right ankle and foot
level sequelaS96.912A
Strain of unspecified muscle
and tendon at left ankle and foot level
initial encounterS96.912D
Strain of unspecified muscle
and tendon at left ankle and foot level
subs encounterS96.912S
Strain of unspecified muscle
and tendon at left ankle and foot level
sequelaS96.919A
Strain of unspecified muscle
and tendon at ankle and foot level,
unspec. side initial encounterS96.919D
Strain of unspecified muscle
and tendon at ankle and foot level,
unspec. side subs encounterS96.919S
Strain of unspecified muscle
and tendon at ankle and foot level,
unspec. side sequela
Information Patterns
ICD‐9 has been evolving over the past 25‐30 years:Changes not consistent throughoutDiffering levels of specificity across chapters
ICD‐10 attempts to standardize levels of specificity and make them consistent across chapters.ICD‐10 classifies conditions by the stage of treatment vs. the episode of care.
ICD‐9 has been evolving over the past 25‐30 years:Changes not consistent throughoutDiffering levels of specificity across chapters
ICD‐10 attempts to standardize levels of specificity and make them consistent across chapters.ICD‐10 classifies conditions by the stage of treatment vs. the episode of care.
ICD‐10 Codes and Descriptions ICD‐9 Codes and Descriptions
026.851
649.51
Spotting complicating pregnancy, first trimester
Spotting complicating pregnancy,
delivered
026.852
649.53
Spotting complicating pregnancy, second trimester
Spotting complicating pregnancy,
026.853
antepartum
Spotting complicating pregnancy, third trimester
026.859
Spotting complicating pregnancy, unspecified trimester
Information Patterns
More extensive vocabulary of clinical concepts, body part specificity, patient encounter information, and other components from which codes are built.
ICD‐9 Code and Description
ICD‐10 Codes and Descriptions
87353
S01521A Laceration with foreign body of lip, initial encounter
Complicated open wound
S01511A Laceration without foreign body of lip, initial encounter
of lip
S01521D Laceration with foreign body of lip, subsequent
encounter
S01511D Laceration without foreign body of lip,
subsequent encounter
S01541A Puncture wound with foreign body of lip, initial
encounter
S01531A Puncture wound without foreign body of lip, initial
encounter
S01541D Puncture wound with foreign body of lip, subsequentencounter
Differences in Classification
Recommended Discovery Tasks for ProvidersJanuary to March 2011• Identify competing projects and determine the priority of
ICD-10.• Identify current systems that use ICD-9 codes.• Identify current reports that contain ICD-9 codes.• Identify current business processes that use ICD-9 codes.• Review vendor contract language to determine if ICD-10
system upgrades are required and included in contract.• Analyze business processes to identify changes required.
Recommended Discovery Tasks for ProvidersApril to June 2011• Contact system vendors to determine if and when an
ICD-10 complete upgrade will be offered.• Analyze revenue and productivity impacts.• Assess staff training needs.• Estimate costs and budgetary implications.• Contact clearinghouses, billing services, and payers to
determine when they will be ready to test.
ICD-10 on Provider Home Page of BCBSRI.com
ICD-10 Landing Page on BCBSRI.com
ICD-10 Noncompliance
• Your claims and other transactions may be rejected.
• You will need to resubmit them with the ICD-10 codes.
• This may result in delays in reimbursement.
Thank you!