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. This basic understanding of the differences will then identify more detailed training that will be
needed to appropriately use the ICD-10 code sets. In addition, seeing the differences between the code
sets will raise awareness of the complexities of converting to the ICD-10 codes.
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.
Diagnosis Codes
In the ICD-10 diagnosis code set, the alpha characters are not case sensitive.The expanded number of characters of the ICD-10 diagnosis codes provides greater specificity to identify
disease etiology, anatomic site, and severity.
ICD-10 Code Structure:
Characters 1-3 – Category
Characters 4-6 – Etiology, anatomic site, severity, or other clinical detail
Characters 7 – Extension
The ICD-10 diagnosis code set also expands on the use of combination codes. Combination codes are a
single code that can be used to classify 1) two diagnoses, or 2) a diagnosis with an associated secondary
process or a diagnosis with an associated complication. Combination codes allow for the reporting of a
single code to express multiple elements of the diagnosis.
The increased specificity of the ICD-10 codes is more flexible, which means that emerging diseases can
be quickly incorporated. The higher level of detail in the codes provides the ability to more precisely code
the diagnosis. As with ICD-9, ICD-10 codes are to be reported at the highest level of detail possible
within the code structure. ICD-10 reflects advances in medicine and medical technology making the code
set more relevant to today’s understanding of diagnoses. ICD-10 also provides an improved ability to
measure health care services and conduct public health surveillance.
The alpha characters in the ICD-10 procedure code set are not case sensitive. The letters O and I are
not used to avoid confusion with the numbers 0 and 1.
The additional characters in the ICD-10 procedure code set allows for identifying the body system, root
operation, body part, approach, and device involved in the procedure.
The ICD-10 code sets are not simply increased and renumbered ICD-9 code sets. The move to ICD-10
will not be easy. The ICD-10 code sets include greater detail, changes in terminology, and expanded
concepts for injuries, laterality, and other related factors. The complexity of ICD-10 provides many
benefits because of the increased level of detail conveyed in the codes. The complexity also underscores
the need to be adequately trained on ICD-10 in order to fully understand reporting changes that will come
with the new code sets.
(Courtesy of the American Medical Association)
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