Part 1: The Differences Between ICD-9 and ICD-10 - Source AMA [American Medical Association]

Alert: The new ICD-10 compliance date is October 1, 2015.

The ICD-10 code sets are not a simple update of the ICD-9 code set. The ICD-10 code sets have fundamental changes in structure and concepts that make them very different from ICD-9. Because of these differences, it is important to develop a preliminary understanding of the changes from ICD-9 to ICD-10. 

Issues today with the ICD-9 diagnosis and procedure code sets are addressed in ICD-10. One concern today with ICD-9 is the lack of specificity of the information conveyed in the codes. For example, if a patient is seen for treatment of a burn on the right arm, the ICD-9 diagnosis code does not distinguish that the burn is on the right arm. If the patient is seen a few weeks later for another burn on the left arm, the same ICD-9 diagnosis code would be reported. Additional documentation would likely be required for a claim for the treatment to explain that the burn treated at this time is a different burn from the one that was treated previously. In the ICD-10 diagnosis code set, characters in the code identify right versus left, initial encounter versus subsequent encounter, and other clinical information.

Another issue with ICD-9 is that some chapters are full and impede the ability to add new codes. In some cases, new codes have been assigned to different chapters making it difficult to locate all available codes. ICD-10 codes have increased character length, which greatly expands the number of codes that are available for use. With more available codes, it is less likely that chapters will run out of codes in the future.

Other issues that are addressed in ICD-10 include the use of full code titles and appropriately reflecting advances in medical knowledge and technology. More detailed information and examples are provided below to demonstrate the differences between the ICD-9 and ICD-10 code sets.

What is ICD?

ICD means International Statistical Classifications of Diseases. ICD codes are alphanumeric designations given to every diagnosis, description of symptoms and cause of death attributed to human beings. These classifications are developed, monitored and copyrighted by the World Health Organization (WHO). In the United States, the NCHS (National Center for Health Statistics), part of CMS (Centers for Medicare and Medicaid Services) oversees all changes and modifications to the ICD codes, in cooperation with WHO

What Do the Numbers Mean? ICD-09, ICD-10 and Others

 ICD codes were first developed in 1893 in France by a physician, Jacques Bertillion. They were called the Bertillon Classification of Causes of Death. In 1898, they were adopted in the United States, and were considered, in effect, ICD-1 because that was the first version of code numbers. Most of the codes we see in the United States today are version 9, called ICD-9-CM codes. With few exceptions, the paperwork we receive when we leave a doctors office will contain both CPT codes (Current Procedural Terminology) to describe the service that was rendered for billing purposes, and ICD-9-CM codes to describe why that service was provided. Further, most death certificates filed since 1977 will have an ICD-9 code on them.

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Healthcare Billing Cycle

The medical billing process in simple words can be described as interaction between health care provider (doctor, nurse, hospital, etc.,) and the insurance company (payer). This process is termed as billing cycle.

The cycle starts when a patient meets the Doctor.. Lets understand the details of each of the steps in the process:

Roles and Responsibilities: