The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is currently being used in most countries. The United States is among a very few industrialized nations still using the ICD-9 code set for diagnosis code reporting. The Department of Health and Human Services (HHS) recently announced their intent to delay the International Classification of Diseases (ICD-10) compliance date. On April 17, 2012, HHS published a proposed rule that provides for a reschedule of the delayed implementation of ICD-10. If finalized, the new rule will change the ICD-10 implementation date to October 1, 2014 from the previously scheduled date of October 1, 2013. ICD-9-CM codes will not be reportable after September 30, 2014.
ICD-10-CM contains 21 chapters listing three to seven digit alphanumeric codes. In 2011, there were slightly more than 69,000 ICD-10-CM diagnosis codes, which equaled about 55,000 more codes than currently exist in ICD-9-CM.
ICD-10-CM allows coding for increased specificity in the reporting of diseases and recently recognized conditions. Further, ICD–10–CM provides noteworthy improvements over ICD–9–CM in coding primary care encounters, external causes of injury, mental disorders, neoplasms, and preventive health. The ICD–10–CM code set reflects advances in medicine and medical technology, permits the capture of more socioeconomics details, ambulatory care condition information, problems related to lifestyle, and the results of screening tests.
The pending ICD-10 implementation means that physicians need to ensure that by October 1, 2014, their chart documentation will support the increased clinical specificity of the new code set. This will enable proper code selection and will result in fewer claim denials.
ICD-10 provides additional clarity that benefits obstetrics and gynecology coding. Some of the obstetrical coding enhancements include:
1. Elimination of episodes of care for obstetric codes
2. Changes in time frames:
a. Abortion vs. Fetal death (20 weeks)
b. Early vs. Late pregnancy (20 weeks)
3. Code extensions to denote the specific fetus in multiple gestation pregnancies
One other notable enhancement is that ICD-10-CM allows the trimester of pregnancy to be designated. Here is an example of the difference:
|649.53 Spotting complicating pregnancy, antepartum
||O26.851 Spotting complicating pregnancy, first trimester
||O26.852 Spotting complicating pregnancy, second trimester
||O26.853 Spotting complicating pregnancy, third trimester
||O26.859 Spotting complicating pregnancy, unspecified trimester
The current draft of ICD-10-CM also provides the ability to report the specific gestational week of pregnancy with codes from category Z3A. Gestational week codes would be reported in addition to codes for complications of pregnancy. Here is an example of the gestational week code structure:
Z3A.0 Weeks of gestation of pregnancy, unspecified or less than 10 weeks
Z3A.00 Weeks of gestation of pregnancy not specified
Z3A.01 Less than 8 weeks gestation of pregnancy
Z3A.08 8 weeks gestation of pregnancy
Z3A.09 9 weeks gestation of pregnancy
Note that the ICD-10-CM diagnostic codes for obstetrical conditions begin with the letter "O".
Annual updates to ICD-9 CM and ICD-10 make transition planning difficult. Vendors, system maintainers, payers, and educators requested a code freeze, so the last regular, annual updates to both ICD-9 CM and ICD were made on Oct 1, 2011. There will be limited code updates in years 2012 - 2014 to capture new technology and new diseases:
October 1, 2011 – last regular updates to ICD-9-CM and ICD-10-CM/PCS occurred
October 1, 2012 and 2013 – partial code freeze, only codes for new technologies and new diseases will be considered for ICD-9-CM and ICD-10-CM/PCS
October 1, 2014 – proposed new implementation date for ICD-10-CM/PCS. Only codes for new technologies and new diseases will be considered for ICD-10-CM/PCS. No new ICD-9-CM codes.
October 1, 2015 – regular updates to ICD-10-CM/PCS will begin one year after implementation of ICD-10-CM/PCS
Providers need to prepare for the change to ICD-10 and educate themselves and their staff on the updated code set.
The implementation delay provides additional time to evaluate and make any needed changes to your documentation process to ensure timely and accurate claims in 2014. As indicated in the examples above, ICD-10 code selection will require a much greater level of detail to be documented due to the granularity of ICD-10.
ACOG is offering multiple ICD-10 training opportunities. For 2013, we have added additional ICD-10 content and examples to our coding webcasts, workshops, and publications to continue the process of helping Fellows and their staff prepare for ICD-10 implementation in 2014.
Please click here for more information on ICD-10, including links to additional resources and the entire ICD-10-CM code set