ICD-10: Fact vs. myth

June 22, 2015
Keith L. Martin
Keith L. Martin

Some common misperceptions about the upcoming Oct. 1, 2015 coding set transition countered with facts from the experts.

Myth: ICD-10 contains ten times the number of codes featured in ICD-9.

Fact: According to the American Health Information Management Association (AHIMA), ICD-10 includes 69,832 diagnosis codes (ICD-10-CM); ICD-9 has 14,567 diagnosis codes. ICD-10 features 71,920 procedure codes; ICD-9 has 3,878 procedure codes. All providers (physicians and hospitals) use the diagnosis codes, but only hospitals reporting inpatient procedures use the procedure codes (ICD-10-PCS). Plus, physicians and practices will, in most cases, use only the codes that apply to their specialty, not the entire set of 141,752 ICD-10 codes.

Other ICD-10 information by the numbers:

  • Left/right distinctions account for 25,626 of the new ICD-10 diagnosis codes; 46% of the increase from ICD-9 to ICD-10

  • There are 39,869 injury and poisoning diagnosis codes in ICD-10 (vs. 2,587 in ICD-9)

  • There are 6,812 external cause of injury codes in ICD-10 (vs. 1,291 in ICD-9)

 

Myth:ICD-10 applies only to those who submit Medicare and Medicaid claims.

Fact: ICD-10 diagnosis and inpatient procedure coding affects every healthcare entity covered by the Health Insurance Portability and Accountability Act.

 

Myth: Payers will not be ready for the ICD-10 transition.

Fact: CMS sats it will be fully prepared for the Oct. 1, 2015 transition. On June 2, CMS announced its second end-to-end testing week with Medicare fee-for-service providers. Approximately 875 providers and billing companies participated, submitting more than 23,000 test claims testing the new code set. Eighty-eight percent of the claims were accepted; 2 percent were rejected due to invalid ICD-10 codes; fewer than 1 percent were rejected due to invalid ICD-9 codes. A similar test in January produced an 81 percent acceptance rate for 661 participants.

CMS is strongly encouraging practices to contact each of their payer partners to get confirmation on ICD-10 readiness by the October start date.

 

Myth: ICD-10 codes are significantly longer and more complex than their ICD-9 counterparts.

Fact: CMS gives the following explanation/example:

ICD-9 codes currently are three to five digits in length: the first digit is alpha (E or V) or numeric; digits two through five are numeric; a decimal is placed after the third character.

For example: Open fracture of shaft of femur-821.11

ICD-10 codes are alphanumeric and seven digits in length: first digit is alpha; second digit is numeric; digits three through seven are alpha or numeric; a decimal is placed after the third character.

For example: Displaced comminuted fracture of shaft of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC - S72.351C

 

Myth:ICD-10 was developed without input from physicians.

Fact: CMS says that both ICD-10-CM and ICD-10-PCS codes involved "significant clinical input" from numerous medical specialty societies.

 

Myth: ICD-10 will be delayed again prior to the scheduled Oct. 1, 2015 transition.

Fact: Currently there is one bill in the U.S. House of Representatives-the Cutting Costly Codes Act of 2015-that would block the Oct. 1 implementation date. Experts believe the bill will not advance out of committee. At the same time, the House Ways and Means health subcommittee is seeking a contingency plan from CMS if the agency cannot handle the new code set as of October.