ICD-10: Fact vs. myth

June 22, 2015

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.

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