Presented by:
Beth Kresse, RHIA, CCS
Susan Waterman, CCS, CPC
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ICD-10 CM
International Classification of Diseases
10th Edition
Clinical Modification
ICD-10 PCS
International Classification of Diseases
10th Edition
Procedure Coding System
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


ICD-9 was implemented in 1979 and is outdated and
inconsistent with current medical practice.
ICD-9 is not able to expand enumeration due to
physical numbering constraints.
ICD-9 has vague and imprecise codes.
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

Effective with encounters and discharge dates on or
after October 1, 2014.
Every application and database in which diagnosis or
procedure codes are captured, stored, analyzed, or
reported will use the new classification system.
Number of Codes
ICD-9
ICD-10
Diagnoses
14,025
68,069
Procedures
3,824
86,000
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 Completeness:
with substantially unique codes
 Expandability:
allows for easy incorporation of
new procedures and diagnoses
 Standardized
methodology: unique definitions
for the terms used
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 Lack
of specificity with ICD-9 creates various
problems:




Inability to collect accurate data on new
technology
Increased requirements for submission of
documentation to support claims
Lack of quality data to support health outcomes
Less accurate reimbursement
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
More accurate payment for inpatient procedures

Improved coding compliance

Clearer understanding of outcomes and quality data

Enhanced disease management

Improved documentation

Greater flexibility for expansion of new codes
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CODERS WILL BE IN EVEN HOTTER
DEMAND THAN THEY ARE NOW!!
Let’s put on our Big Girl Panties and
Take the leap…..
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Codes are the language of healthcare and will
impact virtually all areas of healthcare.
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Where are we currently using ICD-9 codes?
© 3M 2010. All rights reserved.
ICD-10-CM: Diagnosis coding
Used for inpatient and outpatient
ICD-10-PCS: Procedure coding
Used for inpatient only
CPT codes will continue to be used for
outpatient procedure coding
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On September 30, 2014: “I’m calling to preauthorize the admission of Mr. Smith who
has been diagnosed with Crohn’s disease,
diagnosis code 555.0, Regional enteritis of
the small intestine.”
On October 1, 2014: “I’m calling to pre-authorize
the admission of Mr. Smith who has been
diagnosed with Crohn’s disease of the
small intestine with abscess, diagnosis code
K50.014.”
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The principal changes
in ICD-10 CM are in
the:

organization and
structure

code composition

level of detail and
specificity
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 Phrase
that means a way of classifying and
studying diseases.
 Anatomy
is the primary axis of ICD-10 CM.
 Diseases
are assigned to a system
of categories based on established
criteria.
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Feature
ICD-9-CM
ICD-10 CM
Minimum number of
digits/characters
3
3
Maximum number of
digits/characters
5
7
Number of chapters
17
21
V codes and E codes
No
No
Yes
Numeric, except for V codes
and E codes
Alphanumeric
No
Yes
“X”
Supplemental classification
Laterality
Alphanumeric versus numeric
Dummy placeholders
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Fracture of second cervical vertebra, anterior displaced
Type II, initial encounter
S12.110A
Category:
vertebra)
Etiology:
Extension:
S12 (fracture second cervical
110 (anterior displaced Type II)
A (initial encounter)
S 1 2 .1 1 0 A
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Acute gastritis with hemorrhage
K29.01
Category:
Etiology:
Extension:
K29 (acute gastritis)
01 (with hemorrhage)
None
K29 . 0 1
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Codes must be used to the highest number of characters
available. Filler “X” is used for each spot in between the
1st character to the 7th character if required to complete
the code.
T56.0x2S, toxic effect of lead, intentional self-harm,
sequelae
S17.0xxA, laceration with foreign body of scalp, initial
encounter
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ICD-10 CM is very specific with the main
classifications of disease processes.
There are two special groups of codes in addition
to the main classifications.
Factors influencing health status
and
External causes of morbidity
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Specificity looks like this…
ICD-10-CM
ICD-9-CM
821.01 Fracture of
femur, shaft, closed
S72301A Unspecified fracture of shaft
of right femur, initial encounter for
closed fracture
S72322A Displaced transverse fracture S72326A Nondisplaced transverse
of shaft of left femur, initial encounter for fracture of shaft of unspecified femur,
closed fracture
initial encounter for closed fracture
S72301G Unspecified fracture of shaft
of right femur, subsequent encounter
for closed fracture with delayed healing
S72322G Displaced transverse fracture
of shaft of left femur, subsequent
encounter for closed fracture with
delayed healing
S72326G Nondisplaced transverse
fracture of shaft of unspecified femur,
subsequent encounter for closed fracture
with delayed healing
S72302A Unspecified fracture of shaft S72323A Displaced transverse fracture
of left femur, initial encounter for closed of shaft of unspecified femur, initial
fracture
encounter for closed fracture
S72331A Displaced oblique fracture of
shaft of right femur, initial encounter for
closed fracture
S72302G Unspecified fracture of shaft
of left femur, subsequent encounter for
closed fracture with delayed healing
S72323G Displaced transverse fracture
of shaft of unspecified femur,
subsequent encounter for closed
fracture with delayed healing
S72331G Displaced oblique fracture of
shaft of right femur, subsequent
encounter for closed fracture with
delayed healing
S72309A Unspecified fracture of shaft
of unspecified femur, initial encounter
for closed fracture
S72324A Nondisplaced transverse
fracture of shaft of right femur, initial
encounter for closed fracture
S72332A Displaced oblique fracture of
shaft of left femur, initial encounter for
closed fracture
S72309G Unspecified fracture of shaft
of unspecified femur, subsequent
encounter for closed fracture with
delayed healing
S72324G Nondisplaced transverse
fracture of shaft of right femur,
subsequent encounter for closed
fracture with delayed healing
S72332G Displaced oblique fracture of
shaft of left femur, subsequent encounter
for closed fracture with delayed healing
S72321A Displaced transverse fracture S72325A Nondisplaced transverse
of shaft of right femur, initial encounter fracture of shaft of left femur, initial
for closed fracture
encounter for closed fracture
S72333A Displaced oblique fracture of
shaft of unspecified femur, initial
encounter for closed fracture
S72321G Displaced transverse
fracture of shaft of right femur,
subsequent encounter for closed
fracture with delayed healing
S72333G Displaced oblique fracture of
shaft of unspecified femur, subsequent
encounter for closed fracture with
delayed healing
S72325G Nondisplaced transverse
fracture of shaft of left femur,
subsequent encounter for closed
fracture with delayed healing
Many possible codes
And this…..
W15.xxD Fall from cliff,
subsequent encounter
W56.21 Bitten by
an orca
W59.22xA
Struck by a
turtle
T17.1xxS Foreign
body in the nose
T75.3 Seasickness
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
21 chapters

More detailed codes

More space to accommodate future expansions

Creation of more combination codes

Addition of laterality

Extensions
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ICD-9
ICD-10
Late effects
Sequelae
Senile
Age related
Urosepsis
No default to UTI
Diabetes uncontrolled
Diabetes with hyperglycemia
Bilateral
Laterality
MI – acute for 8 weeks
MI – acute for 4 weeks
Accelerated or malignant HTN
HTN
AIDS & HIV
AIDS
Weeks for abortion in Texas is 20
weeks
Standardized weeks for abortion for
all States is 20 weeks
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Combination codes for conditions and common
symptoms or manifestations.

E10.21, Type 1 DM with diabetic nephropathy

I25.110, CAD of native coronary artery with unstable
angina pectoris

K50.112, Crohn’s disease of large intestine with
intestinal obstruction
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Laterality


H60.332,swimmer’s ear, left ear
C50.912, left breast cancer
Extensions - Added 7th characters for episode of
care.

M80.051A, age related osteoporosis with current
pathological fracture, right femur, initial encounter
for fracture
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Extensions required for fractures:
A – Initial encounter for fracture
D – Subsequent encounter for fracture with routine healing
G – Subsequent encounter for fracture with delayed healing
K – Subsequent encounter for fracture with nonunion
P – Subsequent encounter for fracture with malnunion
S - Sequelae
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Extensions required for injuries:
A=
initial encounter, used while the patient is
receiving active treatment
D=
subsequent encounter, used for encounters
for routine healing or recovery phase (cast
change, removal of fixation device, medication
adjustment)
S=
sequelae, used for complications or conditions
that arise as a direct result of a condition (scar after
a burn, steroid induced diabetes)
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Expanded codes for injuries, diabetes, alcohol and
substance abuse, and postoperative complications (old
uh oh codes).

F14.221, cocaine dependence with intoxication
delirium

K91.71, accidental laceration of a digestive system
organ or structure during a digestive system procedure
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Inclusion of trimesters in obstetrics codes. The codes
identify the trimester in which the condition occurred
rather than the episode of care.

O10.012, pre-existing essential hypertension
complicating pregnancy, second trimester

O99.013, anemia complicating pregnancy, third
trimester
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Trimesters are defined as follows:

1st Trimester – less than 14 weeks 0 days

2nd Trimester – 14 weeks 0 days to less than 28 weeks 0
days

3rd Trimester – 28 weeks 0 days until delivery
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7th character extension added to identify the fetus in a
multiple gestation that is affected by the condition being
coded.
0
1
2
3
4
5
6
not applicable or unspecified
fetus 1
fetus 2
fetus 3
fetus 4
fetus 5
other fetus
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
Use both the Alphabetic Index and the Tabular List

Follow all instructional notes

Even if you memorize codes, please check again

Always assign codes to the highest level of specificity

Avoid indiscriminate coding of irrelevant information
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
Epilepsy

HIV/AIDS

Multiple Sclerosis
Incorrect reporting of these conditions can have
serious consequences for the patient if they are not
confirmed.
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Inpatient admissions only….
When a diagnosis is qualified as possible”,
“probable”,“suspected”,“likely”, or
“questionable” at the time of discharge the
condition should be coded and reported as
though the diagnosis was established.
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The guidelines regarding unconfirmed diagnoses does
not apply to coding or reporting for outpatient services.
For these patients, code to the highest degree of
certainty, such as signs and/or symptoms.
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


Signs and symptoms that are part of the disease
process should not be coded.
Codes are not assigned solely on the basis of
diagnostic tests.
Coding of incidental findings with no indication that
care was rendered.
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For both inpatient and outpatient coding……

Code chronic conditions as documented by the
provider if they are under treatment.

Code relevant “history of” codes such as personal
history of major cancers or old MI.

Code relevant “status post” codes such as s/p CABG or
s/p transplant.
Why? ….. Medical Necessity
….. Statistical Reporting
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
How many chapters in ICD-10 CM?

MI is considered acute for how many weeks?

Are decimals used in ICD-10 CM?

Is AIDS coded differently than HIV with ICD-10 CM?

Late effects is termed what in ICD-10 CM?

What is the term for senility?
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Let’s roll into PCS….
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ICD-9-CM Procedure Codes
ICD-10 PCS Procedure Codes
3 – 4 numbers in length
7 alphanumeric characters in length
Based upon outdated technology
Reflects current usage of medical terminology
Lacks laterality
Has laterality (right and left)
Approximately 3,824
Approximately 86,000 codes
Lacks detail
Very specific
Lacks description of methodology and
approach
Provides detailed descriptions of methodology
and approach
Lacks precision to adequately define
procedures
Precisely defines procedures and includes
detail on body part, approach, and devices
used
Limited space for adding new codes
Flexible for adding new codes
Generic terms for body parts
Detailed descriptions for body parts
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

All ICD-10 PCS codes have an alphanumeric structure
with no decimal points and seven characters.
The letters “O” and “I” are not used in PCS so as not to
be confused with the numbers “0” and “1”.

There is a unique code for each procedure.

Structure allows for easy expansion.
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
There are 16 sections of PCS.

The largest section is the Medical and Surgical
section.

There is a separate section for Obstetrics and
Abortions.

Each of the seven characters is an axis of classification
that represents an aspect of the procedure.
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Each procedure code consists of:
Character 1 Section
Character 2 Body system
Character 3 Root operation
Character 4 Body part
Character 5 Approach
Character 6 Device
Character 7 Qualifier
Character
1
Character
2
Character
3
Character
4
Character
5
Character
6
Character
7
Section
Body
System
Root
Operation
Body Part
Approach
Device
Qualifier
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0FT44ZZ – Total laparoscopic cholecystectomy
Section
Body System
Operation
Body Part
0
1
2
3
4
Liver
Liver, right lobe
Liver, left lobe
Gallbladder
Pancreas
0 Medical and Surgical
F Hepatobiliary System and Pancreas
T Resection
Approach
0 Open
4 Percutaneous Endoscopic
Device
Z No Device
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Qualifier
Z No Qualifier
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Character 1: Section
Defines the general type of procedure. There are 16
sections in PCS with the number “0” representing the
Medical and Surgical Section which is the largest section.
Others Include:
Obstetrics
Measurement
Chiropractic
Nuclear Med
Mental Health
Placement
Administration
Osteopathic
Extracorporeal Assistance
Imaging
Extracorporeal Therapies
Rehabilitation
Radiation Oncology
Substance Abuse
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Character 2: Body System
This character indicates the general physiological system
on which the procedure is performed or anatomical
region involved. PCS used 31 body systems.
The diaphragm is used as the frame of reference for body
system classifications for the upper and lower anatomical
regions.
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Central nervous system
Respiratory system
Peripheral nervous system
Skin and breast
Heart and great vessels
Subcutaneous tissue and
fascia
Upper arteries
Lower veins
Ear, nose, sinus
Muscles
Lower bones
Male reproductive system
Head and facial bones
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Character 3: Root Operation
Refers to the objective of the procedure. Mastering the
definitions of the root operations is the key to “building”
a code in PCS. There are 31 root operations in PCS.
The physician is not expected to use the exact
terms used in PCS code descriptions. Instead, it is
the coder’s responsibility to determine what the
documentation in the medical record equates to
the PCS definition.
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Root Operation
Examples
Excision
Breast lumpectomy
Liver biopsy
Resection
Total mastectomy
Total resection of the cecum
Detachment
Above the knee amputation
Traumatic amputation of the ear
Destruction
Ablation of endometriosis
Cautery of nosebleed
Extraction
C-section
Liposuction
Drainage
Thoracentesis
Incision and drainage of perianal abscess
Extirpation
Thrombectomy
Removal of foreign body from the nose
Fragmentation
Lithotripsy
Thoracotomy with crushing of pericardial calcifications
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Root Operation
Examples
Division
Spinal cordotomy
Episiotomy
Release
Arthroscopy with ligament release
Adhesiolysis
Transplantation
Heart transplant
Lung transplant
Reattachment
Reattachment of severed finger
Replantation of avulsed scalp
Transfer
Scalp advancement to temple region
Nerve transfer
Reposition
ORIF
Reposition of undescended testicle
Restriction
Cervical cerclage
Clipping of a cerebral aneurysm
Occlusion
Embolization of uterine artery using coils
Tubal ligation
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Root Operation
Examples
Dilation
PTCA
Dilation of common bile duct
Bypass
CABG
Formation of a colostomy
Insertion
Insertion of PICC
Cochlear implant
Replacement
Total hip replacement
Aortic valve replacement
Supplement
Hernia repair with mesh
Exchange of a liner in femoral component of previous hip
replacement
Change
Exchange of tracheostomy tube
G-tube change
Removal
Removal of external fixation device
Cystoscopy with retrieval of ureteral stent
Revision
Revision of knee replacement
Adjustment of a pacemaker lead
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Root Operation
Examples
Inspection
Diagnostic cystoscopy
Digital rectal exam
Map
Heart catheterization with cardiac mapping
Brain mapping via craniotomy
Control
Control of post tonsillectomy hemorrhage
Ligation of postop arterial bleeder
Repair
Hernia repair without mesh
Closure of chest wall stab wound
Fusion
Spinal fusion
Ankle arthrodesis
Alteration
Face lift
Cosmetic rhinoplasty
Creation
Creation of a penis in a female patient
Creation of a vagina in a male patient
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Reattachment
Transfer – skin graft
for burn
Extirpation of FB in ear
Transplant - Kidney
Extraction
Detachment
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Character 4: Body Part
Defines the specific anatomical site where the procedure
is performed.
Character 5: Approach
Refers to the technique or approach used to reach the
procedure site.
These include external, via the skin or mucous
membrane, or through an orifice.
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Examples:
Open
Percutaneous
Percutaneous endoscopic
Via artificial or natural opening
Via artificial or natural opening endoscopic
External
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Character 6: Device
Used to identify whether a device was used in a
procedure.
Only devices that remain in or on the patient’s body after
the procedure is completed are coded. Incidental
materials, such as, sutures, clips, drains, etc. are not
considered a device.
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Examples:
Skin graft
Joint prosthesis
Pacemaker
Orthopedic pins
Pain pump
Tissue substitute
Gold seed implants
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Character 7: Qualifier
A qualifier has a unique meaning within individual
procedures and is used to provide additional information.
Examples:
Diagnostic biopsy
Donor organ from a cadaver
Heart bypass
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0H0V0JZ - Bilateral breast augmentation with
silicone implants, open approach
0
H
0
Medical and Surgical
Skin and Breast
Alteration
Body Part
T Breast, right
U Breast, left
V Breast, bilateral
Approach
0 Open
3 Percutaneous
X External
Device
7 Autologous tissue
J Synthetic substitute
K Nonautologous tissue
Z No device
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Qualifier
Z No qualifier
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0PSC0ZZ – Open fracture reduction, displaced
fracture of right humeral head
0
P
S
Medical and Surgical
Upper Bones
Reposition
Body Part
C Humeral head, right
D Humeral head, left
F Humeral shaft, right
G Humeral shaft, left
H Radius, left
J Radius, right
Approach
0 Open
3 Percutaneous
4 Percutaneous
endoscopic
Device
4 Internal fixation device
5 External fixation device
6 Intramedullary
B Monoplanar
C Ring
D Hybrid
Z No device
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Qualifier
Z No qualifier
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
Is a suture considered a device?

Name the 7 characters required for a procedure.


The third character for codes located in the Medical
and Surgical section defines the _________.
What is used as the frame of reference for body system
classifications for the upper and lower anatomical
regions?
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Any Questions?
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