ICD-10 is known as the tenth revision of the International Classification of Diseases by the World Health Organization (WHO). It contains codes that offer important information about abnormal diseases, complaints, findings, external causes of various injuries, treating conditions, managing health, symptoms and signs, and social circumstances. ICD-10 holds more than 14,000 codes, and these can be expanded to about 16,000 codes if optional subclassifications are used.
The United States Department of Health and Human Services (HHS) has adopted ICD-10 as a standard code under the Health Insurance Portability and Accountability Act (HIPAA), and it is required to be used by physicians and other healthcare professionals. ICD-10 became effective on October 1, 2015.
ICD-10 has enabled healthcare professionals, coders, IT professionals, government agencies, insurance carriers, and other relevant departments/organizations to identify the disease and record data properly and correctly. Also, to track health trends and to provide assistance in medical reimbursement decisions, ICD-10 has offered great help.
History of ICD-10
The work on the development of ICD-10 began decades ago, and updates used to occur once each decade. The starting effort o ICD-10 was concluded in 1992. After this, ICD-10-CM was introduced for its annual review process in 1992. As compared to ICD-9, ICD-10 is much granular with its expansion of codes, i.e., from 17,000 to about 155,000.
However, many countries shifted to a type of ICD-10 several years ago. For instance, Canada adopted a modified system called ICD-10-CA in the year 2000. Nevertheless, the international version of ICD-10 has been used in 100 countries across the globe for the cause of death reporting and statistics.
Back in 2003, the Health Insurance Portability and Accountability Act of 1996 defined ICD-9 as the standard set of codes for reporting procedures and diagnosis in electronic administrative transactions. On January 16, 2009, the Department of Health and Human Services in the United States published a regulation asking for the replacement of ICD-9 with the new ICD-10 by October 1, 2013.
ICD-10 utilizes the same hierarchical structure that was used by ICD-9. The first three digits are a representation of common traits, with each character offering a greater emphasis on specific details. ICD-10 codes are alphanumeric and have seven digits as compared to ICD-9 codes that have five digits.
Considering the huge changes occurring within the medicine in the year 29313, few authors asked for a delay in ICD-10 implementation. The American Medical association further supported this idea by adopting a policy that favored the delay in implementation.
The Health and Human Services Department then extended the initial date for implementation to October 1, 2014. The discomfort regarding implementation continued even by the new date. However, finally, on October 1, 2015, ICD-10 became effective across the United States.
ICD-10-CM Codes
ICD-10-CM codes have three to seven characters, and the initial three characters tell about the category of code. The category can be expanded to 4, 5, 6, or even 7 characters in order to increase the detail levels. A decimal point is placed optionally between the fourth digital and the category. Digits four, five, and six define the anatomic site, etiology, severity, and other necessary details.
However, the seventh character serves as an extension. Usually, there is a space between the sixth and the seventh digits.
Let’s understand an example code: S86.011D
Here the category os S86 where “S” represents “poisoning, injuries, and various other consequences of external causes that are related to a body’s single regions.” S86 defines “injury of fascia, muscle, and tendon at lower leg.” If we dig deeper:
- S68.0 = Achilles Tendon Injuries
- S68.01 = Achilles Tendon Strain
- S68.011 = Right Achilles Tendon Strain
Lastly, the extension helps to record the episodes of care of injuries and several other conditions with external causes. “A” is the “initial encounter,” whereas “D” is the “subsequent encounter,” and “S” is for “sequela.”
ICD-10-PCS Codes
ICD-10-PCS codes have seven digits, and they, too, are alphanumeric. In contrast to the ICD-10-CM codes, ICD-10-PCS codes do not contain a period. Few examples of these codes are as follows:
7W02X3Z: Osteopathic Treatment of Thoracic Region by using High Velocity-Low Amplitude Forces
XR2H021: Monitoring of Left Knee Joint by using Intraoperative Knee Replacement Sensor, Open Approach, New Technology Group 1
GZ72ZZZ: Family Psychotherapy
These codes, however, describe medical procedures rather than medical diagnoses.
ICD-10-PCS Axes
ICD-10-PCS codes carry seven characters, and each one of them serves as an axis of a classification that represents details about the performed procedure. A character represents the same sort of detail in that classification axis within a pre-defined range of code.
New Technology – X Codes
These are independent codes and this makes them non-supplemental codes. Section X codes completely represent the specific procedure that is defined in the title of code, and thus, any additional code is not required from other ICD-1-PCS sections.
When section X holds a code title that defines a certain new technology procedure, only that X code is documented for the procedure. Therefore, reporting a non-specific, broader code in any other section of ICD-10-PCS is not required.