Development of ICD 10 codes

In the mid 1990's the National Center for Health Statistics (NCHS) found that a clinical modification of ICD 10 Codes would be a significant improvement which should be implemented in the United States. As medical knowledge has increased including emerging diseases, new concepts and the need to expand distinctions for managed care and ambulatory care, a clinical modification was needed. The clinical modification for ICD 10 Codes was created in three phases. The first phase developed with the assistance of a technical advisory panel (TAP) being a prototype. The next two phases incorporated enhancements to the prototype based on the ICD 9 Codes Coordination and Maintenance Committee and public input. The development of the ICD 10 Codes included group discussions with physicians, professional associations (e.g., American Hospital Association, or AHA) and professional licensed coders currently using ICD 9 Codes. As potential problems are identified during the field testing, future improvements are expected. Although ICD 10 Codes are in the public domain, neither the codes nor the code titles can be changed unless approved by the Coordination and Maintenance process overseen together by the Centers for Medicare and Medical Services (CMS) and the National Center for Health Statistics (NCHS). ICD 10 Codes consist of twenty-one chapters. The classification of factors influencing health status and contact with health services (V codes), and the classification of external causes of injury and poisoning (E codes), are incorporated within ICD 10 Codes instead of being considered supplementary classifications, as in ICD 9 Codes.

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Adoption of the ICD 10 codes sets is expected to:

• Support Medicare’s value-based purchasing initiative and antifraud and abuse activities by accurately defining services and providing specific diagnosis and treatment information;

• Provide the precision needed for a number of emerging uses such as pay-for-performance and biosurveillance. Biosurveillance is the automated monitoring of information sources that may help in detecting an emerging epidemic, whether naturally occurring or as the result of bioterrorism;

• Support comprehensive reporting of quality data;

• Ensure more accurate payments for new procedures, fewer rejected claims, improved disease management, and harmonization of disease monitoring and reporting worldwide; and

• Allow the United States to compare its data with international data to track the incidence and spread of disease and treatment outcomes because the United States is one of the few developed countries not using ICD 10 Codes.

ICD 10 Codes will also improve claims processing and payment, and, through the use of health care technology that utilizes ICD 10 Codes, assist health care practitioners in making treatment decisions by more precisely matching diagnoses and procedures to the appropriate code. For example:

• Pressure ulcers are a common condition in elderly Medicare beneficiaries with chronic illnesses. Under the current ICD 9 CM system, health care practitioners can identify the severity or location of a pressure ulcer but the coding system cannot link those elements if the patient has more than one ulcer. Under a single ICD 10 code, a patient’s medical history will identify the severity and location of each pressure ulcer;

• ICD 9 codes have only one code for angioplasty, the widely used procedure for widening a narrowed or obstructed blood vessel. ICD 10 codes provides 1,170 coded descriptions, with a granularity that pinpoints the location of the blockage and the device used for each patient;

• ICD 9 codes do not provide sufficient detail to distinguish whether a condition occurred on a patient’s left or right side. ICD 10 codes will improve care by providing that basic type of information; and
On September 22, 2003, the American Health Information Management Association (AHIMA) and the American Hospital Association (AHA) concluded a field-test study of ICD 10 Codes medical code sets. These findings indicated that the ICD 10 Codes represented a significant improvement over the current ICD 9 Codes coding system. The study also added that the ICD 10 Codes can be implemented without changes in documentation practices or excessive staff training costs.
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• ICD 9 codes include separate codes for medication errors and other external causes of injury, which are reported separately from the actual condition. Under ICD 10 codes, information about medication errors and external causes of injury will be embedded in the code for the condition. Therefore a single, more informative code will provide a ready source of information to help medical professionals prevent medical errors and improve quality of care.
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