ICD-10 Codes: A How-To Guide
The International Classification of Diseases (ICD) is a medical classification list by the World Health Organization (WHO) used by over 25 countries.
The current code set, ICD-9, has been in use for over 30 years. Experts who advocate for its replacement note that ICD-9 lacks recent advances in medical technology and knowledge, and has limited flexibility in classifying complex diagnoses.
Due to these factors, the WHO has created a new code set (ICD-10) that has significantly updated the structure and concepts of ICD-9.
How ICD-10 Impacts Physicians
Converting to ICD-10 codes is mandated for all Health Insurance Portability and Accountability Act (HIPAA)-covered entities. Most providers, including physicians, are HIPAA “covered entities” and must comply.
These codes must be adopted by all medical practices by October 1, 2015. If you haven’t ensured compliance by this date, you and your practice will be vulnerable to cash flow issues and lack of payments for transactions that use ICD-9 codes.
Physicians in solo and small group practices will require a significant amount of support in order to ensure their practice complies with these updates. To help make this process smoother, the Cooperative of American Physicians, Inc. (CAP) has created the ICD-10 Action Guide for Medical Practices.
ICD-10 Codes vs. ICD-9 Codes
Remember: becoming fluent in ICD-10 is more complicated than just trying to cross-map elements from ICD-9. Many of the ICD-10 codes will not directly translate, or may have multiple translations. As difficult as it may be, all office staff must be able to generate and deploy codes using the updated ICD-10 rules.
While there is no simple one-to-one match between ICD-9 codes and ICD-10 codes, there are general equivalence mappings (GEMs) available to assist in translating data from ICD-9 to ICD-10.
The updates made to ICD-10 will help doctors differentiate between right and left for injuries and symptoms, as well as initial or subsequent encounters. Moreover, the new code set has increased the character length of diagnosis codes. This provides greater specificity in identifying disease etiology, anatomic site, and severity.
The result is a code set that provides:
- An increased maximum character length from 5 to 7
- An increase in available codes from 13,000 to 68,000
- Increased flexibility and specificity when adding new codes
The new diagnosis code set also creates additional usage cases for combination codes, which can be used to classify two diagnoses, or a diagnosis with an associated secondary process or complication. This flexibility will allow physicians to use a single code to express multiple elements of a diagnosis, and to classify emerging diseases more quickly.
For nearly 40 years, CAP has supported the finest physicians in California with medical professional liability protection. Our years of experience help us develop benefits and resources so independent physicians like you can thrive in spite of the changes in the medical world.
The ICD-10 Action Guide for Medical Practices is part of our effort to support physicians like you with resources that address everyday needs.