Week 6 – Course Project

Dinae C. Davison, RHIT
HIM 435
Professor Paula Arceneaux
April 14, 2013

Introduction to ICD-10-CM/PCS

The World Health Organization (WHO) is the entity that owns and publishes the International Classification of Diseases (ICD) system (The World Health Organization (WHO), 2013). The United States made modifications to this classification system and in 1979 implemented the use of ICD-9-CM. Since that time healthcare worldwide has evolved and the need to collect more detailed information regarding the diseases and conditions that effect world’s population has become a high priority. Due to this evolution, the ICD-9-CM system has become outdated and can no longer accommodate our needs. Effective October 1, 2014 the United States will implement ICD-10-CM/PCS for use across the nation. Initially we will cover ICD-10-CM and then address ICD-10-PCS.

ICD-10-CM is the classification system to be utilized to record diagnoses identified and treated in both the acute care setting as well as the ambulatory setting. There are various differences between ICD-9-CM and ICD-10-CM and we will highlight several of those differences today. One difference between the two coding classification systems is the number of chapters. ICD-10-CM consists of twenty-one chapters as compared to the seventeen chapters in ICD-9-CM. There are approximately 68,000 diagnostic codes in ICD-10-CM as opposed to the 14,000 in ICD-9-CM (DeVault, Barta, & Endicott, 2012). The length and structure of the codes in ICD-10-CM vary greatly from ICD-9-CM. We have been accustomed to codes being from three to five characters in length. In ICD-10-CM codes can be up to seven characters in length and are alphanumeric in structure. The addition of a seventh character is used for obstetrics, injuries and external causes. ICD-10-CM also uses a placeholder of X (DeVault, Barta, & Endicott, 2012).

In ICD-9-CM we used V and E codes as supplemental classifications, but in ICD-10-CM these have been incorporated into the main classification. Also with ICD-10-CM, the conditions and disease processes associated with the sensory organs (eyes and ears) have been placed in their own chapters as opposed to being incorporated with the nervous system diseases and conditions. Injuries are no longer classified by type as they were in ICD-9-CM, rather they are grouped initially by site and then by type of injury (DeVault, Barta, & Endicott, 2012).

There are many new features with ICD-10-CM. Combination codes are used for conditions and common symptoms or manifestations, as well as poisoning and external causes. ICD-10-CM has also added the use of laterality, seventh characters for episode of care, inclusion of trimesters in obstetrical coding, and added standard definitions for two types of “excludes” notes (DeVault, Barta, & Endicott, 2012).

In October, 2014 the United States will also implement the use of ICD-10-PCS to record procedures performed in the acute care setting. As with the diagnostic coding, there are vast differences in the procedural coding with ICD-10-PCS versus ICD-9-CM Volume 3. In ICD-9-CM procedural codes were numeric and three to four digits in length. This changes to alphanumeric codes that are seven characters in length with ICD-10-PCS (Barta, DeVault, & Endicott, 2012).

As mentioned there are seven characters for each procedural code. Each character can have one of thirty-four values assigned to it (Barta, DeVault, & Endicott, 2012). The structure of the procedural code in ICD-10-PCS is as follows: Character 1 – represents the Section the code is located in such as Medical and Surgical. Character 2 – represents the Body System or anatomical region involved such as Respiratory System or Tendons. Character 3 – represents the Root Operation or the objective of the procedure being performed such as Fragmentation, Bypass or Division. Character 4 – represents the Body Part or specific anatomical site where the procedure is being performed such as Right Lower Arm. Character 5 – represents the Approach or technique used to reach the operative site such as Open. Character 6 – represents the Device, if one is used such as Implants or Grafts and Prosthesis. Character 7 – represents the Qualifier which represents an additional attribute of the procedure, if applicable.

There are sixteen sections in ICD-10-PCS that are represented by the numbers 0 through 9 and the letters B through D and F through H. These sixteen sections are divided into three main sections – Medical and Surgical section, Medical and Surgical-related sections and Ancillary sections (Barta, DeVault, & Endicott, 2012). The tables below indicate the sections contained in ICD-10-PCS:

Section Value | Description | Section Value | Description | B | Imaging | F | Physical Rehab & Diagnostic Audiology | C | Nuclear Medicine | G | Mental Health | D | Radiation Oncology | H | Substance Abuse Treatment | | | | | Section Value | Description | Section Value | Description | 1 | Obstetrics | 6 | Extracorporeal Therapies | 2 | Placement | 7 | Osteopathic | 3 | Administration | 8 | Other Procedures | 4 | Measurement & Monitoring | 9 | Chiropractic | 5 | Extracorporeal Assistance & Performance | | |

As with any other new system there are challenges we must face and overcome with the implementation of ICD-10-CM/PCS. Provider documentation is the foundation that must be in place if accurate coding is expected to occur. Providers must be educated on the importance of being as specific as possible in their documentation of the events that occur during the patient episodes of care. ICD-10-CM/PCS is a classification system that operates on the greatest level of specificity and providers must learn to document that level of specificity.

Coding professionals will have their own challenges to overcome with the implementation of ICD-10-CM/PCS. Even the most seasoned of coders will have some trials and tribulations with this new classification system. It is of utmost importance that coding professionals receive in-depth training in preparation for ICD-10-CM/PCS. Some suggested refresher courses include advanced medical terminology, anatomy and physiology, and clinical pathology and disease processes. The American Health Information Management Association (AHIMA) offers a training boot camp for coding professionals to become AHIMA Approved ICD-10-CM/PCS trainers for their organizations (American Health Information Management Association (AHIMA), 2013). This is a very sound investment to make. Coders will also have to continue having constructive meetings with their providers to ensure effective communication regarding documentation and coding.

There are various changes that need to occur with the automated systems that healthcare organizations utilize for coding and billing. The vast increase in detail and number of codes associated with ICD-10-CM/PCS requires most systems to be reconfigured in order to accommodate the new classification system. Billing officials will also have to update their systems in order to become HIPAA 5010 compliant (US Department of Health and Human Services, 2013).

The United States is scheduled to implement ICD-10-CM/PCS nationwide effective October 1, 2014. Although some say we still have a long time until then, there are preparatory steps that should already be underway in every healthcare organization. Today we covered just a few of the highlights regarding ICD-10-CM/PCS. There is a plethora of information regarding this new classification system available in practically every venue. All HIM professionals are encouraged to do their research, expand on their knowledge and help their organizations prepare for ICD-10-CM/PCS.

References

American Health Information Management Association (AHIMA). (2013). American Health Information Management Association (AHIMA). Retrieved from American Health Information Management Association (AHIMA) web site: www/ahima.org
Barta, A., DeVault, K., & Endicott, M. (2012). ICD-10-PCS Coder Training Manual. AHIMA Press.
DeVault, K., Barta, A., & Endicott, M. (2012). ICD-10-CM Coder Training Manual. AHIMA Press.
The World Health Organization (WHO). (2013). The World Health Organization. Retrieved from The World Health Organization web site: http://www.who.int/about/en/
US Department of Health and Human Services. (2013). Centers for Medicare and Medicaid Services. Retrieved August 10, 2011, from Centers for Medicare and Medicaid Services web site: https://www.cms.gov/