Development of the ICD-10-CM

The 10th revision of the International Classification of Diseases (ICD-10) was issued in 1993 by the World Health Organization (WHO), and WHO is responsible for maintaining it. The ICD-10, the WHO version, does not include a procedure classification (Volume 3). Each world government is responsible for adapting the ICD-10 to suit its own country’s needs. For example, Australia uses the ICD-10-AM, that is, the ICD-10-Australian Modification. Each government is responsible for ensuring that its modification conforms with the WHO’s conventions in the ICD-10. In the United States, the Centers for Medicare and Medicaid Services is responsible for developing the procedure classification entitled the ICD-10-PCS (Procedure Coding System). The National Center for Health Statistics (NCHS) is responsible for the disease classification system (Volumes 1 and 2) entitled ICD-10-CM (CM stands for Clinical Modification).

The ICD-10 is already widely used in Europe, but conversion to the new edition in the United States has taken a great deal of time to implement. One reason for the additional time needed for conversion is that the I-9 is the basis for the hospital inpatient billing system in the United States. Medicare Severity Diagnosis Related Groups (MS-DRGs) is the prospective payment system in place for reimbursement of Medicare hospital inpatient services, and the MS-DRG system is based on the I-9.

ICD-10-CM replaces the icd-9-cm, volumes 1 and 2

The I-10 was developed by the National Center for Health Statistics (NCHS) and will replace I-9, Volumes 1 and 2. Prior to the implementation of the new edition, extensive consultation and review must take place with physician groups, clinical coders, and others. The NCHS established a 20-member Technical Advisory Panel of representatives of the health care and coding communities to provide input during the development of the 10th revision.

In July 2007, the International Classification of Disease, 10th revision, Clinical Modification (ICD-10-CM) was released and replaced the “pre-release draft of June 2003.” In 2009, another updated I-10 was released. In January 2010, another updated version was released. These releases of I-10 were intended for public viewing, but the codes were not valid for any purpose. According to the NCHS, the implementation date for I-10 is October 1, 2013. The material in this text is based on the 2012 version of the I-10. Guidance for the use of I-10 is available at www.cms.gov/ICD10.

Improvements in the ICD-10-CM

Notable improvements in the content and format of the I-10 include the following:

Structure of the system

I-10 contains 21 chapters. Chapter titles in the I-10 remain similar to those in the I-9 with the presence of two new chapters: Chapter 7, Diseases of the Eye and Adnexa, and Chapter 8, Diseases of the Ear and Mastoid Process.

Mapping

As a part of the conversion, two sets of diagnosis code General Equivalence Mappings (GEMs) have been developed. This mapping is a type of crosswalk to find corresponding diagnosis codes between the two code sets. The two GEMs files are:

Figure 1–1 displays GEMs mapping files for codes from I-9 to I-10. Note that the GEMs files do not contain decimal points. For example, in the GEMs file for I-9, code 001.0 is 0010 and code 001.1 is 0011. For I-10 codes, A00.0 is A000 and A00.1 is A001. In Figure 1–1, column 1 displays the I-9 codes and column 2 displays the I-10 codes. Figure 1–2 displays the mapping for codes from the I-10 code system to the I-9 code system. In Figure 1–2, column 1 displays the I-10 code and column 2 displays the equivalent I-9 code. Column 3 in both figures is the “Flag” designation, which will be reviewed next.

Flags

There are three different types of flag designations:

 Approximate

 No Map

 Combination

Approximate

Approximate, flag 0.

The Approximate, Flag 0, means there is a direct match between the two coding systems, and the GEMs file directs the coder to a single entry. The conversion between the two code sets is straightforward: the I-10 code A02.21 maps to 003.21 in the I-9 code system.

Example

003.21 (Salmonella meningitis)

A02.21 (Salmonella meningitis)

Example

I-10	I-9	Flag
A0221	00321	00000

Approximate, flag 1.

The I-10 code set has a more consistent level of detail, such as a more extensive vocabulary of clinical concepts, body part specificity, and patient encounter information. There are five times more codes in the I-10 (69,000+) than in the I-9 (14,000+), so the I-9 code is often linked to more than one I-10 code. The Approximate, Flag 1, assists in the process of conversion by identifying those times when more than one code in the I-10 is available to replace an I-9 code. For example, stress fractures in the I-9 are reported with codes in the 733.93-733.98 range, and although some of the codes are for specific bones (e.g., fibula, metatarsals, femur), a code such as 733.95 reports “other” bones. Code 733.95 is reported when there is not a specific code to report the stress fracture stated in the diagnosis. As such, 733.95 becomes an umbrella code that is assigned to a wide variety of stress fracture diagnoses. The I-10 code set expands the stress fracture codes (M84.3) to be more specific. For example, Figure 1–3 illustrates the specificity of code M84.31, Stress fracture, shoulder.

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1. ICD-10-CM outpatient coding and reporting guidelines
2. Using ICD-10-CM
3. Chapter-specific guidelines (ICD-10-CM chapters 15-21)
4. Chapter-specific guidelines (ICD-10-CM chapters 1-10)

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