ICD-10 DEMYSTIFIED

ICD HISTORY
To fully appreciate where we are headed, it is best to understand a little bit of history on this subject. In 1948, the World Health Organization (WHO) published the first International Classification of Diseases (ICD). This coding system was developed by WHO to provide international consistency for reporting MORTALITY statistics ONLY. Numbers were added with subsequent revisions to identify the new "version". Thus the nomenclature became ICD-2, ICD-3 and so forth. ICD-9 and ICD-10, the most current versions, are copyrighted by the World Health Organization (WHO). ICD-10 is the latest version. Effective January 1, 1999, ICD-10 officially was implemented in the United States for reporting the cause of death on death certificates. For more information on ICD-10, please refer to the WHO website at http://www.who.org

Do NOT panic! Even though ICD-10 was implemented January of 1999, you should not be using it to submit insurance claims right now or ever. It is human nature to shorten what we can. This tendency to abbreviate has created a bit of confusion when it comes to ICD. ICD-9 is NOT the same as ICD-9-CM although they are related. The United States National Center for Health Statistics (NCHS) and the Center for Disease Control (CDC) make it very clear that ICD and ICD-CM are two separate though closely related classification systems. The differences between these two classification systems are explained in the next section.

CLINICAL MODIFICATION (CM) CREATION
When ICD-9 was published by the WHO in 1977, NCHS made a decision to modify the ICD-9 to gather more clinical information and capture MORBIDITY statistics within the US. This modification became known as ICD-9-CM. Thus ICD-9-CM captures both morbidity and mortality statistics for the US. CM is the Clinical Modification created by the US.

Changes to the US CM are made annually through a review process to further clarify some codes and to create new codes needed as a result of discoveries, medical advancements or other administrative reasons. This review process is under the direction of the Centers for Medicare & Medicaid Services (CMS), formerly Health Care Finance Administration (HCFA), the American Hospital Association (AHA) and the National Center for Health Statistics (NCHS).

ICD-9-CM & CLAIMS
When Congress passed the Medicare Catastrophic Coverage Act (MCCA) in 1988, it required the use of ICD-9-CM codes for processing Medicare claims. That act was later repealed, but the requirement of ICD-9-CM codes for Medicare claims was upheld. The ball was set in motion. Much of the insurance industry followed Medicare's lead. Therefore, ICD-9-CM is currently required by third party payors for reporting the clinical diagnosis associated with the procedure(s) performed.

ICD-9-CM TODAY
ICD-9-CM is currently divided into 3 volumes. Volume 1 is a tabular listing of diagnosis codes. Volume 2 is an index for those diagnosis codes. Volume 3 consists of hospital inpatient procedure codes. This may seem rudimentary to some, however, this division is important to understand the proposed coming changes.

ICD-10 CHANGES
There are several changes in the ICD-10. Because of the close relation of ICD-CM to the original ICD, it is important to note that these changes will become part of the ICD-10-CM. Some of the biggest changes are as follows:

1. ICD-10 is much bigger with almost twice the categories of ICD-9.
2. ICD-10 uses alphanumeric categories instead of numeric only.
3. ICD-10 changed chapters, categories, titles and regrouped conditions.

ICD-10-CM
With the release of volume 1 of the ICD-10 in 1992 by WHO, the United States requested and was granted permission to develop an adaptation of ICD-10 for use in the United States for government purposes. Currently, this clinical modification is under way and is being called ICD-10-CM. Other countries have already made or are developing their own modifications of ICD-10 for use within their respective countries.

It has been proposed that ICD-10-CM will replace ICD-9-CM volumes 1 and 2 only. Like the ICD-9-CM system, this new coding system is closely related to its ICD counterpart (ICD-10). Therefore, it closely follows the changes to ICD-10. It contains significantly more codes than the current ICD-9-CM. It is also alpha numeric and has up to seven digits.

Please note that volume 3 (the inpatient procedures) is not included in ICD-10-CM. A separate coding system has been proposed as a replacement called ICD-10-PCS (procedure coding system). This volume 3 replacement is discussed in greater detail under the heading ICD-10-PCS.

ICD-10-CM WHEN?
This is the main question asked by providers. Just when are all these changes going to effect my office? Currently, no one knows for sure. Just like the MCCA of 1988, in 1996 Congress passed the Health Insurance Portability and Accountability Act (HIPAA) and that has created another wrinkle in the time line of ICD-10-CM.

Part of the HIPAA law changes the way that new coding systems are approved in the US. According to The Administrative Simplification requirements, there are new rules to establish national standards for code sets and that these code sets become the national standards two years after publication of the final notice.

Because of these legislated requirements, the May 1999 meeting of the ICD-9-CM Coordination and Maintenance Committee covered this issue. The following information was included in the official minutes:

"There has been a change in the manner in which new coding systems are approved for use in this country. The Administrative Simplification requirements of the Heath Insurance Portability and Accountability Act (HIPAA) require the establishment of national standards for code sets. This act requires proposed and final rules establishing initial national code sets.

A notice of proposed rule making (NPRM) on Transactions was published May 7, 1998 (63 Federal Register (FR) 25272). This NPRM proposes, for the most part, that the existing coding systems become the national standards. For hospital inpatient reporting, the NPRM proposed ICD-9-CM. The comment period closed on July 6, 1998 and the comments are being reviewed. It is anticipated that the final notice will be published in 1999.

Additional information on Administrative Simplification including NPRMs published to date can be found at the following location on the Internet: http://aspe.os.dhhs.gov/admnsimp/

With the pre-release available and the HIPAA request under review, we are getting much closer to the final notice. However, no final notice has been made, so continue using the official HIPAA code sets which include ICD-9-CM.

ICD-10-PCS (Procedure Coding System)
As for Volume 3 of ICD-9-CM, it has been proposed that it be replaced by a new Procedure Coding System called ICD-10-PCS. These procedure codes are not technically part of, nor derived in any shape or form from the ICD-10 by WHO. The current ICD-9-CM volume 3 (inpatient procedure) system was not meeting all the needs of providers and ICD-10 did not include procedures. Therefore, this coding system was contractually developed by 3M Health Information Systems under the direction of the Health Care Finance Administration (HCFA) - now known as the Center for Medicare & Medicaid Services (CMS).

This revolutionary new system (ICD-10-PCS) utilizes a seven digit alphanumeric coding system which allows for completeness, expandability, multi-axial coding and standardized terminology. One major enhancement is the inclusion of qualifier digit(s). These qualifier(s) allows for better documentation of underlying issues affecting the procedure performed. This is something that medical providers have wanted for many years.

This system is being acclaimed as far superior to previous coding systems - namely ICD-9-CM volume 3 used by hospitals and CPT used by other providers. Of course the system is not perfect and some people training with the system right now have expressed some concerns over the sheer volume of new codes. Keep in mind that whenever there is change there will be a learning curve. However, once learned, we believe this system will result in faster and more accurate coding.

Like ICD-10-CM, implementation of ICD-10-PCS falls under the same rules and regulations of HIPAA. This means that there has been no official decision made on when or if ICD-10-PCS will be implemented. It is unknown whether this proposed system will replace volume 3 of ICD-9-CM and/or CPT. It is another "wait and see" situation.

WANT TO KNOW MORE?
To help you learn and bridge the gap between ICD-9 and ICD-10, InstaCode Institute has made the following products available.

ICD-10-PCS TRAINING MANUALS

• Download Files: We have the PDF files for the training manual, the index, and the tabular listing for ICD-10-PCS which you may download for only $10. This one step installation includes Adobe Acrobat Reader 4.0 and lets you print out just those sections applicable or of interest to you.  
  Order & Download Here.
  
• HARD COPY: The training manual is also available as a book from 3M Health Information Systems for $20 (plus S&H). The index and tabular listings are $100 (incl S&H).

Glossary of Terms

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