A doctor was overheard asking his medical coder: “What's the ICD-10 code for high blood pressure due to stress from switching to ICD-10?” That about sums it up. There's a lot of chatter about ICD-10, including questions about how medical coders will deal with the transition.
What's the difference between ICD-9 and ICD-10?
Before talking about the differences between ICD-9 and ICD-10, it's important to understand one of the most complicated aspects of the U.S. ICD-10 adoption. Doctors technically aren't adopting ICD-10 as the WHO designed it. The WHO's ICD-10 actually has fewer diagnosis codes and less specificity than ICD-9-CM, which is the U.S. modification on ICD-9. As a result, the U.S. is modifying the ICD-10 as well, but into two conjoined code sets: The ICD-10-CM (Clinical Modification) and the ICD-10-PCS (Procedural Coding System). For the sake of convenience, in the U.S., ICD-10 is shorthand for ICD-10-CM and ICD-10-PCS.1
The difference between the U.S. modifications of ICD-9 and ICD-10 is significant1:
- ICD-10-CM contains 68,000 existing codes while ICD-9-CM has only 13,000.
- ICD-9 codes consisted of only five characters; the first alphanumeric and the other four numeric. ICD-10 codes consist of seven characters, however, all of which are alphanumeric.
- The difference in character count and alphanumeric limitations allows for more information to be shared in an individual code.
- Terminology is modernized to more appropriately and accurately reflect today's understanding of disease and diagnosis.
- Some ICD-10 codes combine diagnosis with symptom. As a result, fewer overall codes are necessary to fully report on patient condition.
- ICD-10 can report on laterality designating whether the left or right part of the body is being evaluated.
- ICD-10 improves obstetric diagnoses through classifying patients by trimester of pregnancy rather than individual episode of care.
How is the ICD-10-CM different from the ICD-10-PCS?
ICD-10-CM represents the clinical modification of the WHO's original code set. It's used for diagnosis within practices and hospitals across the country. ICD-10-PCS, on the other hand, is a procedural coding system. Unlike the diagnostic CM, PCS will be used exclusively in hospitals. Operating rooms, nursing and inpatient care will all use PCS to report procedural services. The American Academy of Professional Coders noted that ICD-10-PCS has nothing to do with ICD-10 as the WHO intended. It primarily serves as a replacement to ICD-9-CM Procedure Codes, and has only been attached to ICD-10 by the Centers for Medicare and Medicaid Services as both coding systems work through the MS-DRG system (Medicare's diagnosis-related group).2
PCS has some advantages over previous iterations2:
- PCS also features seven characters rather than the previous five.
- It allows inpatient hospital procedures to be coded uniquely, making them easier to distinguish.
- Like the new ICD-10-CM, PCS includes flexibility for expansion.
- PCS features updated and modern terminology.
Where can I find ICD-10 coders?
You probably already know, October 1, 2015 is the deadline for physicians, practices and hospitals to implement ICD-10. As a result, graduates from medical billing and coding programs that include ICD-10 in the curriculum are expected to be in high demand. Ultimate Medical Academy has just such a program. At UMA, ICD-10 coders are in the pipeline.