International classification of diseases, 10th edition, clinical modification and procedure coding system: descriptive overview of the next generation HIPAA code sets

Abstract

Described are the changes to ICD-10-CM and PCS and potential challenges regarding their use in the US for financial and administrative transaction coding under HIPAA in 2013. Using author constructed derivative databases for ICD-10-CM and PCS it was found that ICD-10-CM's overall term content is seven times larger than ICD-9-CM: only 3.2 times larger in those chapters describing disease or symptoms, but 14.1 times larger in injury and cause sections. A new multi-axial approach ICD-10-PCS increased size 18-fold from its prior version. New ICD-10-CM and PCS reflect a corresponding improvement in specificity and content. The forthcoming required national switch to these new administrative codes, coupled with nearly simultaneous widespread introduction of clinical systems and terminologies, requires substantial changes in US administrative systems. Through coordination of terminologies, the systems using them, and healthcare objectives, we can maximize the improvement achieved and engender beneficial data reuse for multiple purposes, with minimal transformations.

Measuring Comprehensiveness of Primary Care: Challenges and Opportunities

“…This method entails analyzing the number of conditions listed for evaluation and management (E&M) visits, as identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (BICD-9-CM") codes. 71 Because claims may list co-conditions that physicians are not necessarily treating, the Graham Center measure utilizes a ranked frequency distribution of all conditions treated over the course of a year by each physician. It then tallies the number of ICD-9-CM codes that account for the distribution below a given threshold value (e.g., 80% of ICD-9 codes).…”

There Are Important Reasons For Delaying Implementation Of The New ICD-10 Coding System

“…In fact, ICD-10-CM devotes a staggering 60 percent of its codes to injuries-including lamppost injuries 2 -compared to 15 percent in ICD-9-CM. 7 In the course of most usual care, such rich and varied coding options may simply amount to clutter. And although it might be natural to presume that ICD-10-CM reflects an up-to-theminute view of health care and medicine compared to the now-antiquated ICD-9-CM, we argue that such an assumption is only partially correct.…”

“…In contrast, ICD-10-CM devotes only 30 percent of its 68,000 codes, or roughly 20,000 codes, to disease entities. 7 However, many of the new codes introduced in ICD-10-CM relate to identifying laterality or episode codes, such as first or subsequent treatment episode. Thus, the difference between the 20,000 disease codes in ICD-10-CM and the 8,500 in ICD-9-CM is an overestimate of the difference between the two versions of ICD because of the variants in ICD-10-CM attributable to laterality and episode modifiers.…”

Estimating and Analysing Coordination in Medical Terminologies

“…INTRODUCTION 1 Controlled medical terminologies have long played an important role in the drive to improve patient care, e.g., in Electronic Health Records (EHR), decision support and expert systems, medical literature databases, and data exchange [1], [2]. A large number of medical terminologies have been developed, including the Systemized Nomenclature of Medical Clinical Terms (SNOMED CT) [3], the International Classification of Diseases and Related Health Problems, 9th Revision -ICD-9 and more recently its 10th Revision, ICD-10 both with Clinical Modifications (CM) and Procedure Coding System (PCS) [4], [5], and the National Cancer Institute (NCI) thesaurus.…”