ShopIngenix: What is ICD-10 Coding? ICD10 Overview

ICD-10-CM: Guideline Spotlight ICD-10-CM: Coding Scenario

ICD-10-PCS: Guidelines Spotlight ICD-10-PCS: Coding Scenario

Limited Code Updates During ICD-10-CM/PCS Transition

Rumors of a code freeze for ICD-9-CM and ICD-10-CM and ICD-10-PCS during the transition to the new coding system are just that—rumors. The ICD-9-CM Coordination and Maintenance Committee clarified during its meeting March 9 and 10, 2011, that there will be no reprieve from code updates to give providers time to implement the new codes, although the updates will be “limited.”

By “limited,” the committee means the updates will aim to reflect advances in medicine so as to comply with the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. L. 108-173, section 503[a]). The act stipulates that code sets reflect new technologies and diseases. Since significant medical advances will continue to be made, the code sets will continue to be updated.

While “limited” updates are intended to be restricted to reflect emergent diseases and new technology, the possibility of necessary corrections and adjustments to the code sets has not been ruled out. This leaves the potential for the limited update to include more than mere compliance with the Medicare Prescription Drug Act.

Those who do not want to be caught flat-footed come October 1, 2013, will start familiarizing themselves with ICD-10-CM and ICD-10-PCS now and keep up with the updates to both coding systems until the transition is complete. Eighteen months is not a lot of time for revamping entire coding processes and systems, training coders, and refreshing coders’ understanding of anatomy, physiology, pathophysiology, pharmacology, and medical terminology.

For the 2012 editions, both code sets will get their full, regular, annual updates. For October of 2012, the updates to both sets will be limited 2013 editions to reflect new technologies and diseases—this will be the last update for ICD-9-CM. The following year, 2013, only ICD-10-CM and ICD-10-PCS will receive a limited 2014 edition update, again reflecting only new technologies and diseases; ICD-9-CM will no longer be valid. Effective October 1, 2014, and every year thereafter, ICD-10-CM/PCS will receive a full, regular, annual update.

Note that there will be no grace period for implementing ICD-10-CM and ICD-10-PCS codes for entities covered under the Health Information Portability and Affordability Act (HIPAA). ICD-10-CM codes will be required for reporting all diagnoses on claims for services provided on or after October 1, 2013, and ICD-10-PCS codes will be required to report services on all facility inpatient hospital claims as of that date. ICD-9-CM codes will be invalid for reporting diagnoses and services provided after October 1, 2013.

	October 1, 2011 2012 editions	October 1, 2012 2013 edition	October 1, 2013 2014 edition	October 1, 2014 2015 edition
ICD-9-CM	Last regular, annual update	Limited update*	No longer valid	No longer valid
ICD-10-CM/PCS	Regular, annual update	Limited update*	Limited update*	Regular, annual update

* Changes to codes will reflect only new technologies and diagnoses.

Entities not covered under HIPAA, such as workers’ compensation plans, are not required to transition from ICD-9-CM codes, but the vast majority are expected to switch to the new coding systems. Not only will the data coming from ICD-10-CM and ICD-10-PCS claims be more specific, but the new coding systems will be the only ones maintained and updated. Using ICD-9-CM past 2013 will lead to coding that does not accurately reflect the diagnoses treated and services performed.

To begin our preparation for change, let's address some of the most frequently asked questions that coders ask regarding ICD-10-CM and the guidelines. Click Here

Q: What are the similarities and differences between ICD-9-CM and this new system?

A: Below is a side by side comparison of some of the differences and similarities between the two classification systems:

ICD-9-CM		ICD-10-CM
	3-5 digits- numeric		3-7 digits; alphanumeric, not case sensitive
	17 Chapters - body system based - same order		21 Chapters - body system based - same order
	Supplemental chapters E and V codes - alphanumeric codes		No supplemental chapters
	General conventions		General conventions
	Official coding guidelines		Official coding guidelines
	Chapter specific coding guidelines		Chapter specific coding guidelines
	Index and Tabular sections		Index and Tabular sections
	Neoplasm Table and Table of Drugs as part of the Index to Disease		Index- two sections Index to Disease and Injury
	Tabular List has Categories ( 3 digit), subcategories (4 digit) , subclassification codes( 5 digit)		Neoplasm Table and Table of Drugs as part of the Index to Disease
	No placeholder		Tabular List has categories ( 3 digit), subcategories (4, 5 or 6 digits), Extensions (7th character)
	Punctuation [ ] ( ) : } [ ]		Placeholders ('x') (5th character) for future expansion
	Other specified (NEC) and unspecified (NOS) codes		Punctuation - No braces, No slanted brackets
	"And" means "and/or"		Other specified (NEC) and unspecified (NOS) codes
	Includes notes and Includes terms		"And" means "and/or"
	Excludes note		Includes notes and Includes terms
	Manifestation/etiology convention "in conditions classified elsewhere"		Excludes notes- two types Excludes 1 (Not coded here) and Excludes 2 (Not included here)
	"Code first", "Use additional code", and "Code also" notes		Manifestation/etiology convention "in conditions classified elsewhere"
	Index notations: See See also See condition Morphology codes (M codes) Indent structure Main term - condition Omit code		"Code first", "Use additional code", and "Code also" notes
			Index notations: See See also See condition Morphology codes (M codes)- omitted Indent structure Main term - condition Antiquated terms are gone