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Coding – ICD-10-CM…

In This Issue:

About the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Note: The July 2007 release of ICD-10-CM is now available for review, however, it is not yet implemented for practical use.

The National Center for Health Statistics (NCHS), the Federal agency responsible for use of the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) in the United States, has developed a clinical modification of the classification for morbidity purposes. The ICD-10 is used to code and classify mortality data from death certificates, having replaced ICD-9 for this purpose as of January 1, 1999. ICD-10-CM is planned as the replacement for ICD-9-CM, volumes 1 and 2.

The ICD-10 is copyrighted by the World Health Organization (WHO), which owns and publishes the classification. WHO has authorized the development of an adaptation of ICD-10 for use in the United States for U.S. government purposes. As agreed, all modifications to the ICD-10 must conform to WHO conventions for the ICD. ICD-10-CM was developed following a thorough evaluation by a Technical Advisory Panel and extensive additional consultation with physician groups, clinical coders, and others to assure clinical accuracy and utility.

The entire draft of the Tabular List of ICD-10-CM, and the preliminary crosswalk between ICD-9-CM and ICD-10-CM were made available on the NCHS website for public comment. The public comment period ran from December 1997 through February 1998. The American Hospital Association and the American Health Information Management Association conducted a field test for ICD-10-CM in the summer of 2003, with a subsequent report.

The clinical modification represents a significant improvement over ICD-9-CM and ICD-10. Specific improvements include:

* addition of information relevant to ambulatory and managed care encounters
* expanded injury codes
* creation of combination diagnosis/symptom codes to reduce the number of codes needed to fully describe a condition
* addition of sixth and seventh characters
* incorporation of common 4th and 5th digit subclassifications
* greater specificity in code assignment

The new structure will allow further expansion than was possible with ICD-9-CM.
An updated July 2007 release of ICD-10-CM is now available for public viewing. However, the codes in ICD-10-CM are not currently valid for any purpose or use (as of July 1, 2008). There is not yet an anticipated implementation date for the ICD-10-CM. Implementation will be based on the process for adoption of standard under the Health Insurance Portability and Accountability Act of 1996.

World Health Organization (WHO)

International Classification of Diseases (ICD)

ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as from 1994. The classification is the latest in a series which has its origins in the 1850s. The first edition, known as the International List of Causes of Death, was adopted by the International Statistical Institute in 1893. WHO took over the responsibility for the ICD at its creation in 1948 when the Sixth Revision, which included causes of morbidity for the first time, was published.

The ICD has become the international standard diagnostic classification for all general epidemiological and many health management purposes. These include the analysis of the general health situation of population groups and monitoring of the incidence and prevalence of diseases and other health problems in relation to other variables such as the characteristics and circumstances of the individuals affected.

It is used to classify diseases and other health problems recorded on many types of health and vital records including death certificates and hospital records. In addition to enabling the storage and retrieval of diagnostic information for clinical and epidemiological purposes, these records also provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States.

Overview:

International Statistical Classification of Diseases and Related Health Problems
10th Revision
Version for 2007
Tabular List of inclusions and four-character subcategories

Chapter List
Chapter Blocks Title
I A00-B99 Certain infectious and parasitic diseases
II C00-D48 Neoplasms
III D50-D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
IV E00-E90 Endocrine, nutritional and metabolic diseases
V F00-F99 Mental and behavioural disorders
VI G00-G99 Diseases of the nervous system
VII H00-H59 Diseases of the eye and adnexa
VIII H60-H95 Diseases of the ear and mastoid process
IX I00-I99 Diseases of the circulatory system
X J00-J99 Diseases of the respiratory system
XI K00-K93 Diseases of the digestive system
XII L00-L99 Diseases of the skin and subcutaneous tissue
XIII M00-M99 Diseases of the musculoskeletal system and connective tissue
XIV N00-N99 Diseases of the genitourinary system
XV O00-O99 Pregnancy, childbirth and the puerperium
XVI P00-P96 Certain conditions originating in the perinatal period
XVII Q00-Q99 Congenital malformations, deformations and chromosomal abnormalities
XVIII R00-R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
XIX S00-T98 Injury, poisoning and certain other consequences of external causes
XX V01-Y98 External causes of morbidity and mortality
XXI Z00-Z99 Factors influencing health status and contact with health services
XXII U00-U99 Codes for special purposes

Look at the above index, note the first entry under Chapter 1, Blocks and Title is 1 (chapter), A00-B99 (block) and is termed “Certain infectious and parasitic diseases.

Under Chapter 1, the following blocks are further subcategorized.
Section Title
A00-A09 Intestinal infectious diseases
A15-A19 Tuberculosis
A20-A28 Certain zoonotic bacterial diseases
A30-A49 Other bacterial diseases
A50-A64 Infections with a predominantly sexual mode of transmission
A65-A69 Other spirochaetal diseases
A70-A74 Other diseases caused by chlamydiae
A75-A79 Rickettsioses
A80-A89 Viral infections of the central nervous system
A90-A99 Arthropod-borne viral fevers and viral haemorrhagic fevers
B00-B09 Viral infections characterized by skin and mucous membrane lesions
B15-B19 Viral hepatitis
B20-B24 Human immunodeficiency virus [HIV] disease
B25-B34 Other viral diseases
B35-B49 Mycoses
B50-B64 Protozoal diseases
B65-B83 Helminthiases
B85-B89 Pediculosis, acariasis and other infestations
B90-B94 Sequelae of infectious and parasitic diseases
B95-B97 Bacterial, viral and other infectious agents
B99 Other infectious diseases

Now look at the next table and you will see the individual block numbers listed under the subcategory of Intestinal infectious diseases.
Block A00 to A00.9 (intestinal infectious diseases)
Section Title
A00 Cholera
A00.0 Cholera due to Vibrio cholerae 01, biovar cholerae
A00.1 Cholera due to Vibrio cholerae 01, biovar eltor
A00.9 Cholera, unspecified

Let’s code a disease:

Using the above information, here is an example of how you would code using ICD10.

Coding example:
If the patient’s chart showed s/he had cholera due to Vibrio cholerae, it would be coded from Chapter 1 (listed above), subcategory A00-B99, then finding the detail of A00 to A00.9. You can see the A00.0 has the description you want, so you would code it as A00.01. The book will have an alpha lookup just like the ICD9 has always had.

Where to Find the Information on ICD10. You may review the actual codes in PDF Formats – Most of the documents on the following website are provided as downloadable ZIP files in Adobe PDF Format.
http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm

New Files, July 2007

* Preface
* Index
* Tabular
* Table of Drugs and Chemicals
* General Equivalence Mapping Files

Addendum:

On Friday, August 15, 2008, HHS issued a proposed rule that would require healthcare providers to adopt ICD-10 code sets for electronic health transactions by October 2011, Government Health IT reports.

Healthcare providers currently use ICD-9 code sets, which were developed about 30 years ago and no longer can be expanded effectively to include codes for new diseases and procedures. ICD-9 can accommodate about 17,000 codes, while ICD-10 had space for more than 155,000 codes.

In a statement, HHS Secretary Mike Leavitt said that adopting ICD-10 code sets is a necessary step toward developing a Nationwide Health Information Infrastructure. He added, “The greatly expanded ICD-10 code sets will enable HHS to fully support quality reporting, pay for performance, biosurveillance and other critical activities.”

This information is provided so that you will understand how you can easily adapt to a new coding system based upon what you have learned with Meditec’s Coding Training Program. Once you understand how basic ICD and CPT codes work, you will be able to move into any other coding devised without any difficulty.