Conversion from ICD-9-CM to ICD-10-CM/PCS
Recently I have been getting an increasing number of questions regarding the conversion from ICD-9-CM to ICD-10-CM/PCS. I think it is important to have a general understanding of the educational and financial burden that the health care industry is about to tackle, so I put together the following overview in an effort to inform those of you that have not had a chance to research this subject further.
- The compliance date for conversion to the new coding system is October 1, 2013.
- The number of diagnoses codes will escalate from 14,025 (ICD-9) to 68, 069 (ICD-10). Yes, you read that right; there is going to be a 54,044 increase in the number of diagnoses codes under the new coding system.
- The number of procedure codes will escalate from 3,824 (ICD-9) to 72,589 (ICD-10); an increase of 68,765 in the number of procedure codes.
- Structural differences will include an increase from 3-5 digits in diagnoses codes (ICD-9) to 3-7 digits in diagnoses codes (ICD-10), and all ICD-10 codes will be alpha-numeric
- ICD-10-CM will replace ICD-9-CM Diagnoses and ICD-10-PCS will replace ICD-9-CM Procedures.
If you are wondering why the coding system is going through this exhaustive conversion, the answer is actually quite simple. ICD-9 is over thirty years old and it did not keep up with the evolution of the health care industry. ICD-9 is not exact enough to identify diagnoses and procedures precisely, and it is not flexible enough to incorporate emerging diagnoses and procedures.
CMS offers the following example in a CMS overview presentation on ICD-10 (pdf) to help illustrate the concept:
Example – fracture of wrist
Patient fractures left wrist. A month later, fractures right wrist.
ICD-9-CM does not identify left versus right.
However, ICD-10-CM describes:
- Left versus right
- Initial encounter, subsequent encounter
- Routine healing, delayed healing, nonunion, or malunion
While the road to conversion will likely be rough (I am recalling my first few experiences with Microsoft Vista), the result will be an accurate, accountable and measurable coding system that increases productivity, while decreasing audits, the need for supporting documentation and the delay in receiving reimbursement from health insurance companies.
