The Transition from ICD-9 to ICD-10 Coding

By October 14, 2015Articles, Health

The classification of causes of death was first developed in the 1800s[1]. Since then, the classification has been revised 10 times to reflect changes in the medical field. It now includes a list of causes of death and of diseases using a set of codes to allow physicians to provide a high level of detail regarding the injury and the patient encounter. This set of codes is now referred to as the International Classification of Diseases (ICD). In its 10th revision (ICD-10), the code was implemented on October 1, 2015 in the U.S. health care system and replaced the 9th revision (ICD-9). ICD-10 includes codes for Clinical Modification (ICD-10-CM) indicating medical diagnoses and a Procedure Coding System referred to as CD-10-PCS. The ICD-10 has more than 76,000 codes[2].

Transitioning from ICD-9 to ICD-10 allows physicians to provide more detailed information about the patient’s injury and about the clinical encounter[3]. For example, ICD-10 allows a provider to indicate which arm sustained an injury and, if the patient was seen subsequently, the code specifies which encounter was initial or subsequent. One disadvantage of the ICD-9 was that it did not allow this level of specificity. Additionally, some of the chapters were full and it was no longer possible to add new codes. Overall, use of the ICD-10’s seven digits will allow the health care system to expand the number of codes, and make it less likely to run out of codes in the future should new illnesses be diagnosed.

Regarding structure, the ICD-10-CM is composed of codes with three, four, five, six, or seven digits. The first three digits are headings that may be further subdivided by digits four to seven to provide more detail regarding the illness. The first digit is alpha, the second digit is numeric, digits 3-7 can be alpha or numeric, and there is a decimal after the third digit. The following examples provide sample ICD-10 codes: A78 for Q fever; A69.21 for Meningitis due to Lyme disease; or S52.131a for Displaced fracture of neck of right radius, initial encounter for closed fracture.

In the future, it will be important for anesthesiologists to master ICD-10 codes in order to improve their chances of being reimbursed for services[4]. This will, in turn, result in increased revenue, less paperwork and improved patient care. For this reason, anesthesiologists should take advantage of ICD-10 training opportunities, especially since many of these trainings are free and readily available online.

Anesthesiologists submitting Medicare claims should note that Medicare no longer accepts ICD-9 codes for services provided after September 30, 2015. Additionally, the system does not accept claims containing both ICD-9 and ICD-10 codes for a service.

Implementation of the ICD-10 system will still require anesthesiologists to report Current Procedural Terminology (CPT) codes for anesthesia and non-anesthesia procedures as many insurers link the CPT code to the diagnosis code to determine medical necessity. The CPT codes include five-digit procedure codes as well as modifier codes[5]. Modifiers are two digits that can either be alpha or numeric. They allow clarification of the services to be billed and do not change procedure codes. Advantages of modifiers include: providing more information by specifying, for example, the anatomical site; eliminating duplicate billing; allowing health care providers to charge for services separately rather than in a bundle; increasing accuracy in reimbursement; improving coding consistency; and enhancing the capture of payment data.

Modifiers that are specific to anesthesia include:

AA – Anesthesia Services performed personally by the anesthesiologist

AD – Medical Supervision by a physician; more than 4 concurrent anesthesia procedures;

G8 – Monitored anesthesia care (MAC) for deep complex, or markedly invasive surgical procedures;

G9 – Monitored anesthesia care for patient who has a history of severe cardiopulmonary condition

QK – Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals

QS – Monitored anesthesia care service

QX – Certified Registered Nurse Anesthetists (CRNA) service; with medical direction by a physician

QY – Medical direction of one certified registered nurse anesthetist by an anesthesiologist

QZ – CRNA service; without medical direction by a physician.

In sum, it is exciting that ICD-10 CM codes have replaced ICD-9 codes. This new system will allow anesthesiologists to report the diagnosis codes and indicate the need for the anesthesia services. To limit denial of claims or the need to resubmit claims that are rejected, anesthesiologists should report codes as accurately as possible.[6] As insurers can deny claims based on the use of diagnosis codes that are invalid, anesthesiologists should verify that patients are eligible for reimbursement and that the services claimed are covered.