According to CMS, the transition to ICD-10 is occurring because ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures; the data set is 30 years old, has outdated terms, and is inconsistent with current medical practice; and the structure of ICD-9 limits the number of new codes that can be created. ICD-10 contains significantly more codes than the previous iteration of the data set, and the codes are longer.
Explore This IssueSeptember 2015
In ICD-9, there are approximately 14,000 diagnosis codes and 3,800 procedure codes, totaling about 17,800. By comparison, ICD-10 has nearly 70,000 diagnosis codes and nearly 72,000 procedure codes, for a total of almost 142,000 codes.
In addition to the increased quantity of codes, the code structure is different. Although there are some similarities (e.g., the hierarchal structure, the meanings of the symbols, and the criteria for code assignment of the principal diagnosis code), some differences will take getting used to. The most significant difference is the code structure: ICD-9 codes contain three to five characters, while ICD-10 codes contain up to seven alphanumeric characters. Furthermore, the “V” and “E” codes from ICD-9 are being discontinued, and the sixth digit in ICD-10 will mainly be numeric and will identify laterality and drug poisoning.
Because there’s frequently not a one-to-one conversion, single codes in ICD-9 may translate to multiple possibilities in ICD-10. Cerumen (wax) impaction is an example, said Richard Waguespack, MD, clinical professor in the department of surgery, division of otolaryngology at the University of Alabama at Birmingham (UAB). The ICD-9 code is 380.4. “Under ICD-10, there will be additional and more specific codes, one of which should not be used (H61.20 impacted cerumen unspecified ear): H61.21 impacted cerumen right ear, H61.22 impacted cerumen left ear, and H61.23 impacted cerumen bilateral (both) ears,” he explained.
The AAO-HNS has provided numerous resources to try to mitigate the burden of ICD-10 implementation on physicians, including workshops, webinars, and online resources. One example is the AAO-HNS partnership with the American Association of Professional Coders (AAPC) to provide special access to “ICD-10 Documentation Training for Physicians” and “ICD-10-CM Specialty Code Set for Otolaryngology,” as well as other AAPC online training tools and courses.
Legislatively, efforts have been made to stall or adapt the switch to ICD-10. H.R. 2247, the ICD-TEN ACT, which was introduced by Rep. Black (R-Tenn.) in May 2015, includes an 18-month safe harbor period. H.R. 3018, the Code-FLEX Act of 2015, was introduced by Rep. Blackburn (R-Tenn.) in July and included a stipulation that ICD-9 codes continue to be accepted in parallel with ICD-10 codes for six months after the switch. Both bills were still in committee as of early August.