A new era of coding for diagnoses is coming on October 1, 2013. The International Classification of Diseases 9th Revision, Clinical Modification, or ICD-9, is running out of codes to manage the hundreds of new diagnosis codes that are submitted by specialty societies and quality monitoring agencies. The new set of codes identified as ICD-10 was approved by the Department of Health and Human Services and have greater specificity and epidemiological tracking for disease management with over 68,000 codes in its system. Presently, there are approximately 14,000 ICD-9 codes available.
The diagnoses codes were created to provide codes for diseases and a wide variety of signs, symptoms, complaints, and abnormal findings. The codes—which include procedural codes—have a uniform language across the wide spectrum of medicine and are the national coding standard for physicians and other healthcare professionals.
The effectiveness of the coding nomenclature depends on regular updates to reflect changes in the practice of medicine. With new clinical trials, medical devices, and disease management, the codes for both diagnoses and procedures are revised and updated to reflect proper billing guidelines and reimbursements.
New Practice Management Books
The ACR has published two new e-books to assist ACR and ARHP members with practice management: Business Side of Rheumatology and Rheumatology Coding Manual. These reference guides can be viewed online or downloaded and printed. Visit www.rheumatology.org/practice to get your copy.
Structural Differences between the Two Coding Systems
Diagnoses Codes
ICD-9-CM diagnoses codes are three to five digits long. For example:
725—Polymyalgia rheumatica
714.0—Rheumatoid arthritis
V58.64—Long-term (current) use of nonsteroidal antiinflammatories
ICD-10-CM diagnoses codes—still in draft form—are three to seven characters in length, alphanumeric, and not case sensitive. For example:
D86—Sarcoidosis
M06.9—Rheumatoid arthritis, unspecified
S52.131a—Displaced fracture of neck of right radius, initial encounter for closed fracture
The greater number of combinations allows ICD-10-CM to expand and keep up with new diagnoses and share disease data internationally at a time when such sharing is critical for public health.
The ICD-10 coding system consists of 21 chapters, which is slightly more than the current ICD-9 outline, which has only 17 chapters. New chapters were added to supplementary classifications of external causes of morbidity as well as factors that would influence any health status. Also, some conditions were reassigned to different chapters due to new knowledge of the disorder or disease. For example, in the current ICD-9 manual, gout is presently classified in Chapter 3, “Endocrine, Nutritional and Metabolic Diseases and Disorders.” In ICD-10, gout was moved to Chapter 13, “Diseases of the Musculoskeletal and Connective Tissue,” which is more in line with the correct categorization of the disease. In addition, ICD-10 for rheumatology lies in the coding of anatomy—the musculoskeletal system and connective tissue section is expanded for more specificity of anatomical detail, especially in the coding of digits.