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
ICD-9-CM diagnoses codes are three to five digits long. For example:
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:
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.
Code changes are not new to the coding world because diagnosis code changes are always updated and effective October 1 of each year (CPT code changes are always effective January 1). These dates should be embedded in the minds of rheumatologists and their staffs to avoid any backflow in payments and reimbursements for services provided. This is very important, because if a deleted code is billed on the HCFA 1500, payors will deny reimbursement for medical necessity.
For example, the 2011 code for spinal stenosis (lumbar region) has two new codes that include additional coding notes, detailed description, and associated index data:
2010 ICD-9 Code
- 724.01 Lumbar region
2011 ICD-9 Codes
- 724.01 Lumbar region, without neurogenic claudication
Lumbar region, NOS
- 724.03 Lumbar region, with neurogenic claudication (new code for 2011)
Rheumatology practices can experience a flow of denials if this new code change is not billed correctly. Rheumatologists must use and document the most appropriate diagnosis and procedure code in patients’ medical records. Third-party payors and the Centers for Medicare and Medicaid Services no longer give a grace period to use new or revised codes.
Medical coding is an intricate part of your practice and has become more extensive through the years due to population growth and mortality data. It is vital that you keep abreast of the annual code changes and even more so with the new coding system that will arrive by early 2012!
For more information on ICD-10 coding, contact Antanya Chung at firstname.lastname@example.org or (404) 633-3777, ext. 818. For any other coding and billing information, contact Melesia Tillman, CPC, CHA, CRHC, at email@example.com or (404) 633-3777, ext. 820.