Basic

Introduction to
ICD-10 CM/PCS
ICD-10 Implementation
 October1, 2015 – Compliance date for
implementation of ICD-10-CM (diagnoses)
and ICD-10-PCS (procedures)

 ICD-10-CM (diagnoses) will be used by all

providers in every health care setting

 ICD-10-PCS (procedures) will be used only

for hospital claims for inpatient hospital
procedures
◦ ICD-10-PCS will not be used on physician claims,
even those for inpatient visits
CPT and HCPCs Codes
 Noimpact on Current Procedural
Terminology (CPT) and Healthcare
Common Procedure Coding System
(HCPCS) codes

 CPT and HCPCS will continue to be used

for physician and ambulatory services
including physician visits to inpatients
ICD-10 Implementation
Singleimplementation date of
October 1, 2015 for all users

Ambulatory and physician services

provided on or after October 1,
2015 will use ICD-10-CM diagnosis
codes

Inpatient discharges occurring on or

after October 1, 2015 will use ICD-
10-CM and ICD-10-PCS codes
Why ICD-10
Current ICD-9 Code Set is:
 Outdated: 30 years old
 Current code structure limits amount of new
codes that can be created
 Has obsolete groupings of disease families
 Lacks specificity and detail to support:
◦ Accurate anatomical positions
◦ Differentiation of risk & severity
◦ Key parameters to differentiate disease manifestations
Diagnosis Code Structure
Comparison
ICD-9-CM (Volume 1 & 2) ICD-10-CM

3-5 characters in length 3-7 characters in length

Approximately 14,000 codes Approximately 68,000 codes
First digit may be alpha (E or Digit 1 is alpha (to indicate the
V) or numeric; digits 2-5 are category);
numeric Digit 2 is numeric (in the
future, alpha characters may
be used if code expansion is
needed);
Digits 3-7 can be alpha or
numeric
Limited space for adding new Flexible for adding new codes
codes
Lacks detail Very specific
Lacks laterality Includes laterality (i.e., codes
identifying right vs. left)
ICD-10-CM (diagnosis) Code
Format
2nd – Always Numeric
Alpha 3rd-7th Alpha or Numeric Additiona
(except l
U) Characte
rs

S 3 2 0 1 0 A
Category Etiology, Anatomic
Site, Severity

Added code extensions (7th

3-7 Character) for obstetrics, injuries and
external causes of injuries
Comparison: ICD-9 to ICD-
10
434.11 Cerebral I63.40 Cerebral infarction dew to
embolism of unspecified
embolism with cerebral artery
infarction I63.49 Of other cerebral artery
I63.411 Of right middle cerebral artery

Code represents embolism of I63.412 Of left middle cerebral artery

cerebral arteries with I63.419 Of unspecified middle cerebral

artery
infarction
I63.421 Of right anterior cerebral artery
I63.422 Of left anterior cerebral artery

I63.429 Of unspecified anterior cerebral

artery
I63.431 Of left posterior cerebral artery
With specificity and I63.432 Of right posterior cerebral artery
laterality, one ICD-9
I63.439 Of unspecified posterior cerebral
code translates into 14 artery
possible ICD-10 codes I63.441 Of right cerebellar artery

I63.442 Of left cerebellar artery

I63.449 Of unspecified cerebellar artery

Procedure Code Structure
Comparison
ICD-9-CM (Volume 3) ICD-10-PCS

3-4 numbers in length 7 alpha-numeric characters in

length
Approximately 3,000 codes Approximately 87,000
available codes
Based on outdated technology Reflects current usage of
medical terminology and
devices
Limited space for adding new Flexible for adding new codes
codes
Lacks detail Very specific
Lacks laterality Has laterality
Generic terms for body parts Detailed descriptions for body
parts
Lacks descriptions of Provides detailed descriptions
methodology and approach for of methodology and approach
procedures for procedures
ICD-10-PCS Code Format

S 3 2 0 1 0 A
Sectio Root Approac Qualifi
n Operatio h er
n
Body Body Device
Syste Part
m
Comparison: ICD-9 to
ICD-10
ICD-9 Procedure Code
39.50 Angioplasty
39.31 Suture of artery
47.01 Laparoscopic appendectomy

ICD-10 Procedure Code

0DN90ZZ Release of duodenum, open approach
0FB03ZX Excision of liver, percutaneous approach,
diagnostic
02PS0CZ Removal, extraluminal device from pulmonary
vein, right, open
ICD-10 Provider Impacts
 Clinical documentation is the foundation of successful
ICD-10 Implementation
 Golden Rule of Documentation
◦ If it isn’t documented by the physician, it didn’t happen
◦ If it didn’t happen, it can’t be billed

 The purpose in documentation is to tell the story of what

was performed and what is diagnosed accurately and
thoroughly reflecting the condition of the patient
◦ what services were rendered and
◦ what is the severity of the illness

 The key word is SPECIFICITY

◦ Granularity
◦ Laterality

 Complete and concise documentation allows for accurate

coding which leads to maximized reimbursement
ICD-10 Changes
Everything!
 ICD-10 is a Business Function Change, not
just another code set change.

 ICD-10 Implementation will impact everyone:

◦ Registration, Nurses, Managers, Lab, Clinical Area,
Billing, Physicians, and Coding.

 Knowyour role – How is ICD-10 going to

change what you do?
ICD-10 Next Steps
 Assess & track vendor compatibility

 UHS Master Education Plan

◦ Identify all employees and medical staff who
need training by April 15, 2015.
◦ Assign all Precyse Courses in Healthstream by
April 30, 2015.
 Be mindful of assigned staff training hours

 Dual coding / practicing with ICD-10-CM/PCS

ICD-10 Facility Resources
 Cost centers have been established specifically for the
resources needed to implement ICD-10 successfully.
This covers both the training of employees and any
necessary back-fill of staff during training.
◦ ICD -10 Training: coded to account #xxx-86100-687923

 Two ICD-10 translation tools:

◦ Code Translation Tool (CTT)
 Translates ICD-9 to ICD-10 utilizing description, specific code, code ranges or
list of codes.
 Training and Roll-out of the CTT tool has been completed and end users are
actively using the tool for Code translation needs.
◦ Financial Impact Tool (FIT)
 Analyzes historical DRG data to predict the financial impact of ICD-10, both
positive and negative. Variance reports can be utilized to identify avoidable
DRG shifts in order to reduce financial risk through physician documentation
education.
 Training and Roll-out of the FIT tool is in progress.
ICD-10 Resources
 CMS Resources
◦ MS-DRG Conversion Report
[Link]
[Link]

◦ ICD-10 General Information

[Link]

 Thefollowing organizations offer providers and

others ICD-10 resources
◦ AHIMA (American Health Information Management
Association) [Link]
◦ WEDI (Workgroup for Electronic Data Interchange)
[Link]
◦ HIMSS (Health Information and Management Systems
Society) [Link]
 E R 1 ,
C T O B
O ! !
2 0 1 5
QUESTIONS?