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How Big is the Change to ICD-10?
To understand the scope of this change, consider a few key points:
- There are approximately 69,000 diagnosis codes in ICD-10 compared to approximately 14,000 diagnosis codes in ICD-9
- ICD-10 codes contain 3-7 digits; ICD-9 codes contain 3-5 digits
- Diagnosis codes are key elements of many electronic systems, such as practice management and electronic health records
- Diagnosis codes are also key to many health insurance coverage policies and are used in pay-for-reporting and pay-for-performance initiatives
- While many conventions of ICD-9 carry over to ICD-10, there will be a need for physicians, coders, and billers to learn proper use of the new code set
As these points indicate, the transition from ICD-9 to ICD-10 will involve many processes within and outside your practice. Coordination with hardware and software vendors, claims clearinghouses, and payers will be necessary.
Code comparisons
To get even more of an idea of what this change means, it may be helpful to look at a few codes.
Some changes are not bad. Using ICD-9, a physician's notation of hypertension is often reported as 401.9, hypertension, unspecified or 401.1, hypertension, benign. Using ICD-10, a physician's notation of hypertension may be reported with the simple three-digit code I10, essential (primary) hypertension.
Others get a bit more complex. Take, for instance, coding of acute gout of right big toe with no cause specified. In ICD-9, the code might be 274.01, acute gouty arthropathy.
ICD-10 is much more specific. To the base code of M10, a fourth digit must be added to indicate whether the gout is idiopathic, lead-induced, drug-induced (code first the T code for the drug), due to renal impairment, an other secondary gout, or unspecified. Once you have the fourth digit, a fifth digit indicates the affected body area and a sixth digit may be necessary to indicate right, left, or unspecified. The corresponding ICD-10 might be M10.071, gout, idiopathic, right ankle and foot. (Alternatively, M10.9, gout, unspecified, might be reported but would not represent coding to the highest level of specificity.)
The table below illustrates the variables in determining a code for the diagnosis of gout.
Some changes are not bad. Using ICD-9, a physician's notation of hypertension is often reported as 401.9, hypertension, unspecified or 401.1, hypertension, benign. Using ICD-10, a physician's notation of hypertension may be reported with the simple three-digit code I10, essential (primary) hypertension.
Others get a bit more complex. Take, for instance, coding of acute gout of right big toe with no cause specified. In ICD-9, the code might be 274.01, acute gouty arthropathy.
ICD-10 is much more specific. To the base code of M10, a fourth digit must be added to indicate whether the gout is idiopathic, lead-induced, drug-induced (code first the T code for the drug), due to renal impairment, an other secondary gout, or unspecified. Once you have the fourth digit, a fifth digit indicates the affected body area and a sixth digit may be necessary to indicate right, left, or unspecified. The corresponding ICD-10 might be M10.071, gout, idiopathic, right ankle and foot. (Alternatively, M10.9, gout, unspecified, might be reported but would not represent coding to the highest level of specificity.)
The table below illustrates the variables in determining a code for the diagnosis of gout.
| Gout | Type | Location | Laterality | Code |
|---|---|---|---|---|
| M10. | 0 | 7 | 1 | M10.071 |
| 0 idiopathic | 1 shoulder | 1 Right | ||
| 1 lead-induced | 2 elbow | 2 Left | ||
| 2 drug-induced | 3 wrist | 9 Unspecified | ||
| 3 due to renal impairment | 4 hand | |||
| 4 other secondary gout | 5 hip | |||
| 9 gout, unspecified | 6 knee | |||
| 7 ankle & foot | ||||
| 8 vertebrae | ||||
| 9 mult. Sites |
ICD-10-CM
How Big is the Change to ICD-10?
How Can Practices Prepare for ICD-10?
