Comprehensive Health Insurance: Billing, Coding, and Reimbursement, Chapter 5
Additional Readings
Required Readings
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
Improving your ICD-10 Diagnosis Coding
Supplemental Readings
ICD-10

ICD-10 (International Classification of Diseases, Tenth Revision)

Medical Coding Vocabulary and Key Terms

ICD-10-CM

Using ICD-10-CM
Supplemental Videos
Lecture Notes

UNDERSTANDING ICD-10-CM CODING

On October 1, 2015, the ICD-10-CM officially replaced the ICD-9-CM coding system. ICD-9-CM had been around for a while, and many found it a limiting system that didn’t really reflect expanded diagnoses and updated technologies. In the ICD-10-CM system, the codes have been greatly expanded to provide more detail. ICD-9-CM contained 13,000 codes, but the ICD-10-CM system has more than 68,000 diagnostic codes! Additionally, ICD-9-CM codes were numeric, but the expanded ICD-10-CM codes are alphanumeric and have been designed to allow for new codes to be added to them, which was one of the major problems with the ICD-9-CM system.

You may be feeling overwhelmed by the sheer number of codes, but don’t worry! There are coding books as well as coding software that will help you understand codes and how to use and assign them. You’ll never be expected to memorize 68,000 individual codes. However, if you work with codes regularly, you’ll start to naturally memorize the codes you work with the most. It just happens.

The ICD-10 system also introduced changes for procedure codes. In addition to the ICD-10-CM diagnosis changes, ICD-10 also replaced the use of procedure codes in ICD-9-CM with ICD-10-PCS, where the PCS stands for Procedure Coding System Replacement. The ICD-10-PCS system is used for hospital inpatient procedures only.

BEFORE ICD-10: AN INTRODUCTION TO CODING

The International Classification of Diseases, or ICD, is the standard diagnostic tool for epidemiology, health management, and clinical purposes. It was created to

Monitor the incidence and prevalence of diseases

Keep track of health problems

Analyze the health of like groups

Report and provide statistics
Classify diseases
Provide for the storage and retrieval of diagnostic information
Record national mortality and morbidity statistics
Provide a system for reimbursement
Help providers understand resource allocation
ICD-9-CM stands for the International Classification of Diseases, Ninth Revision, Clinical Modification, and until its replacement with ICD-10-CM/PCS in 2015, it was the official system in the United States for assigning codes to diagnoses and procedures for hospital stays. It was based on the World Health Organization’s (WHO) initial Ninth Revision, International Classification of Diseases (ICD-9). However, the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS) are the U.S. government agencies responsible for overseeing changes and modifications to the ICD-9 and ICD-10. Though ICD-9-CM has already been replaced by ICD-10-CM/PCS, it’s important that you learn the basics of ICD-9-CM coding, as many healthcare facilities are still transitioning to the new system.
ICD-9-CM consisted of three volumes:
Volume 1: A numerical list of the disease code numbers in tabular form
Volume 2: An alphabetical index to the disease entries
Volume 3: An alphabetic index and tabular list of surgical, diagnostic, and therapeutic procedures
ICD-10 is very similar to ICD-9 and consists of
Volume 1: Tabular lists containing cause-of-death titles and codes and inclusion and exclusion terms for cause-of-death titles
Volume 2: Descriptions, guidelines, and coding rules
Volume 3: An alphabetical index to diseases and nature of injury, external causes of injury, and table of drugs and chemicals
The ICD-9-CM coding system was originally published in the three volumes just discussed. Later editions separated the hospital and outpatient sections. The process of correctly coding diagnoses is challenging. In addition to the procedure of actually selecting the correct code from the code book, there’s a more significant element that we must discuss. The main point to remember (and this isn’t covered in your text) is that the quality of the information you receive from the physician is what determines the ultimate quality of the code. You must develop an effective communication system with your physician to obtain a correct and complete diagnosis, including all secondary and concurrent conditions. Effective communication between you and your physician can be accomplished by means of the patient’s chart, the encounter form, or other special forms used within the office. Whatever the method of communication, you must receive timely and accurate information from the physician. Try to remember that you and the physician are a team with the same goal of reimbursement.
The importance of accurate diagnostic coding can’t be stressed enough. Incorrect coding can have serious consequences, including lawsuits. It’s imperative that you have a system in place to obtain all the correct information from the physician before you code diagnoses. Once you have an accurate, written, and complete diagnosis from your physician, you can begin to find the codes.

This assignment begins by discussing the different types of diagnoses, including primary versus principal diagnoses. In some instances, a comorbidity diagnosis might be appropriate for certain patients.
Note that the term principal procedure applies only to a procedure performed for definitive treatment, rather than diagnostic purposes. Secondary procedures are additional procedures performed during the same encounter as the principal procedure. Be sure you understand the difference between these two terms.
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