CHALLENGES AND FORCES:
WHAT YOU NEED TO KNOW, ICD 10
Michael D. Paquin, FHIMSS
T
• Preventing and detecting health care
he topic of ICD-10 and all that it
entails seems to have been around
for a few years, and hopefully all of
the ICD-10 material and education
you have been exposed to have
gotten the point across that it is rather
important to the entire healthcare industry and
it merits all of the attention and focus it is
(hopefully) receiving. The implementation
delay has perhaps lessened its perceived
degree of importance when compared to more
pressing issues across the industry, so maybe it
is a good time to review the basics of ICD-10.
fraud and abuse; and
• Tracking public health and risks.
Non-specific codes still exist for use when
the medical record documentation does not
support a more specific code.
Similarities and Differences
between the Two Coding Systems
ICD-10-CM uses 3-to-7 alpha and numeric
digits and full code titles, but the format is
very much the same as ICD-9-CM (e.g.,
ICD-10-CM has the same hierarchical structure
as ICD-9-CM).
The 7th character in ICD-10-CM is used in
several chapters (e.g., the Obstetrics, Injury,
Musculoskeletal, and External Cause
chapters). It has a different meaning
depending on the section where it is being
used (e.g., in the Injury and External Cause
sections, the 7th character classifies an initial
encounter, subsequent encounter, or
sequelae [late effect]).
Primarily, changes in ICD-10-CM are in its
organization and structure, code composition,
and level of detail.
Benefits of ICD-10
ICD-10-CM incorporates much greater
clinical detail and specificity than ICD-9-CM.
Terminology and disease classification have
been updated to be consistent with current
clinical practice. The modern classification
system will provide much better data
needed for:
• Measuring the quality, safety, and efficacy
of care;
• Reducing the need for attachments to
explain the patient’s condition;
• Designing payment systems and
processing claims for reimbursement;
• Conducting research, epidemiological
studies, and clinical trials;
• Setting health policy;
• Operational and strategic planning;
• Designing health care delivery systems;
• Monitoring resource utilization;
• Improving clinical, financial, and
administrative performance;
ICD-9-CM Diagnosis Codes
• 3-to-5 digits;
• First digit is alpha (E or V) or numeric
(alpha characters are not case sensitive);
• Digits 2-to-5 are numeric; and
• Decimal is used after third character.
Examples:
• 496 - Chronic airway obstruction, not
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