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ICD-9-CM (International Classification of Diseases, 9th edition, Clinical Modifications) is a set of codes used by physicians, hospitals, and allied health workers to indicate diagnosis for all patient encounters. The ICD-9-CM is the HIPAA transaction code set for diagnosis coding.

The current International Classification of Diseases can trace its roots back to the Bertillon Classification first published in 1893. Starting in 1900, experts met about every 10 years under the auspices of the French government to revise the classifications. The fifth revision was published just before World War II. The World Health Organization took over responsibility for ICD in 1946 with publication of ICD-6. The intended purpose of the ICD-9 diagnosis codes (Volume 1 and 2) is for statistical tracking of diseases. Nothing more. Codes are added only when it can be demonstrated that it will help in the identification and monitoring of the disease.

The current edition in the United States for morbidity classification, ICD-9-CM, has been in use since 1979. The original intent for the diagnosis codes was for epidemiological and not billing functions, although in the US, the codes are used by payers for billing and reimbursement purposes.

ICD-9 diagnosis codes consist of 3-5 numeric characters representing illnesses and conditions, and alpha-numeric E codes, describing external causes of injuries, poisonings, and adverse effects; and V codes describe factors influencing health status and contact with health services.

ICD-9-CM consists of three volumes. Physicians use Volumes 1 and 2 only to assign diagnosis codes. Physicians use Current Procedural Terminology (CPT), published by the American Medical Association, to report medical and surgical procedures and physician service codes, rather than Volume 3 of the ICD-9-CM codes. The 3rd Volume of ICD-9-CM is used by Hospitals for reporting inpatient procedures and resource utilization.

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There are several revisions to ICD-9-CM that affect Emergency Medicine for 2010. The updates were effective October 1, 2009. The new code changes include for example: the following new codes:

View a complete list of 2009 ICD-9-CM revisions, additions, and deletions

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ICD-10-CM is the long awaited diagnosis code revision to ICD-9-CM. There is another set of codes known as ICD-10-PCS (Procedure Coding System). ICD-10-PCS will be discussed in another FAQ below.

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On January 16, 2009, the Department of Health and Human Services released the HIPAA Administrative Simplification: Modifications to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS Final Rule (CMS-0013-F). The compliance date for implementation of the ICD-10-CM/PCS Coding System is October 1, 2013 for all covered entities.

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Frankly, ICD-9-CM is running out of codes. Hundreds of new diagnosis codes are submitted by medical societies, quality monitoring organizations and others annually. ICD-10-CM will allow not only for more codes but also for greater specificity and thus better epidemiological tracking. This will allow providers to better identify certain patients with specific conditions that will benefit from tailored disease management programs, e.g. diabetes, hypertension, asthma.

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The ICD-10-CM codes are very different from those currently used in ICD-9-CM. All codes in ICD-10-CM are alpha-numeric. There may be up to seven alpha-numeric characters, requiring billing software program changes to accommodate the additional digits, as well as extensive coder training. There will be little change in what the physician documents in the medical record; it is how the information is "translated" into ICD coding that will change. ICD-10-CM codes will be able to provide more in depth information about the patient's condition that can be more easily captured in an electronic medical record. Physician (HCFA 1500) and hospital (UB-04) billing forms have been updated to accommodate the changes.

Just as with ICD-9-CM, clear physician documentation will be important in aid in assigning appropriate ICD-10-CM codes.

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General Equivalence Mappings (GEM) were developed by CMS and CDC, with collaboration of the AHIMA and the AHA, as a tool to assist with the conversion from ICD-9-CM codes to ICD-10-CM and the conversion of ICD-10-CM codes back to ICD-9-CM. The GEMs are forward and backward mappings between the ICD-9-CM and ICD-10-CM coding systems and are also referred to as crosswalks since they provide important information linking codes of one system with codes in the other system.

In some instances, there is not a translation between an ICD-9-CM code and an ICD-10-CM code. When there is no plausible translation from a code in one system to a code in the other system, a "No Map" flag indicator is noted.

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ICD-10-PCS (Procedure Coding System) is currently designated to replace Volume 3 of ICD-9-CM for hospital inpatient use. The cooperating parties and especially CMS have made it very clear that there is no intention for ICD-10-PCS to in any way, shape or form to replace CPT for the identification of physician work. Its only intention is to identify inpatient facility services in a way not directly related to physician work but directed towards allocation of hospital services.

CPT remains the procedure coding standard for physicians, regardless of whether the physician services were provided in the inpatient or outpatient setting. Any third party payer asking for Volume 3 procedure codes to be submitted along with CPT codes for outpatient services is in violation of HIPAA regulations and subject to fines by CMS.

Some preliminary inpatient hospital testing of ICD-10-PCS has indicated that the new procedure coding system is problematic to learn for both experienced and inexperienced coders.

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There have been many questions as to the cost of implementing ICD-10. The RAND Science and Technology Policy Institute is publishing its findings on the cost and benefits of implementing ICD-10. According to the draft executive summary, providers will incur costs for computer reprogramming, the training of coders, physicians, and code users, and for the initial and long-term loss of productivity among coders and physicians. The cost of sequential conversion (10-CM then 10-PCS) is estimated to run $425M to $1.15B in one-time costs plus somewhere between $5 and $40 million a year in lost productivity.

RAND assumes the benefits as largely coming from the additional detail that ICD-10-CM and ICD-10-PCS would offer. The benefit of more accurate payments to hospitals for new procedures ranges from $100M to $1.2B. Benefits from fewer rejected claims would be $200M to $2.5B and $100M to $1B for fewer exaggerated claims. The identification of more cost-effective services and direction of care to specific populations would result in a benefit of $100M to $1.5B. This is in addition to any benefits that would come from better total disease management and better directed preventive care.

Blue Cross and Blue Shield sponsored a study to determine costs to the health care industry in adopting ICD-10-CM and ICD-10-PCS. The study indicated a cost range of $5.5-13.5 billion for systems implementation, training, loss of productivity, re-work, and contract re-negotiations during a 2-3 year implementation period. Over half of the costs would be borne by health care providers. Long term recurring costs for loss of productivity were estimated at $150 million to $380 million.

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Yes, ICD-10 has been in use throughout the world for both morbidity and mortality statistics since 1994. It has been required for reporting mortality statistics in the United States since 1999.

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For an in-depth discussion of the features and challenges of ICD-10-CM and ICD-10-PCS, check the link below:

• http://www.cms.gov/ICD10/