ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.Work on ICD-10 began in 1983, became endorsed by the Forty-third World Health Assembly in 1990, and was first used by member states in 1994.
The International Classification of Diseases (ICD) is the international "standard diagnostic tool for epidemiology, health management and clinical purposes." Its full official name is International Statistical Classification of Diseases and Related Health Problems.
Medical classification, or medical coding, is the process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers. The diagnoses and procedures are usually taken from a variety of sources within the health care record, such as the transcription of the physician's notes, laboratory results, radiologic results, and other sources.
The World Health Organization (WHO) is a specialized agency of the United Nations that is concerned with international public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organisation, was an agency of the League of Nations.
Whilst WHO manages and publishes the base version of the ICD, several members states have modified it to better suit their needs. In the base classification, the code set allows for more than 14,000 different codesand permits the tracking of many new diagnoses compared to the preceding ICD-9. Through the use of optional sub-classifications ICD-10 allows for specificity regarding the cause, manifestation, location, severity and type of injury or disease. The adapted versions may differ in a number of ways, and some national editions have expanded the code set even further; with some going so far as to add procedure codes. ICD-10-CM, for example, has over 70,000 codes.
Procedure codes are a sub-type of medical classification used to identify specific surgical, medical, or diagnostic interventions. The structure of the codes will depend on the classification; for example some use a numerical system, others alphanumeric.
The WHO provides detailed information regarding the ICD via its website – including an ICD-10 online browser and ICD training materials. The online training includes a support forum, a self learning tool and user guide.
The following table lists the chapter number (using Roman numerals), the code range of each chapter, and the chapter's title from the international version of the ICD-10.
The numeric system represented by Roman numerals originated in ancient Rome and remained the usual way of writing numbers throughout Europe well into the Late Middle Ages. Numbers in this system are represented by combinations of letters from the Latin alphabet. Roman numerals, as used today, employ seven symbols, each with a fixed integer value, as follows:
|I||A00–B99||Certain infectious and parasitic diseases|
|III||D50–D89||Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism|
|IV||E00–E90||Endocrine, nutritional and metabolic diseases|
|V||F00–F99||Mental and behavioural disorders|
|VI||G00–G99||Diseases of the nervous system|
|VII||H00–H59||Diseases of the eye and adnexa|
|VIII||H60–H95||Diseases of the ear and mastoid process|
|IX||I00–I99||Diseases of the circulatory system|
|X||J00–J99||Diseases of the respiratory system|
|XI||K00–K93||Diseases of the digestive system|
|XII||L00–L99||Diseases of the skin and subcutaneous tissue|
|XIII||M00–M99||Diseases of the musculoskeletal system and connective tissue|
|XIV||N00–N99||Diseases of the genitourinary system|
|XV||O00–O99||Pregnancy, childbirth and the puerperium|
|XVI||P00–P96||Certain conditions originating in the perinatal period|
|XVII||Q00–Q99||Congenital malformations, deformations and chromosomal abnormalities|
|XVIII||R00–R99||Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified|
|XIX||S00–T98||Injury, poisoning and certain other consequences of external causes|
|XX||V01–Y98||External causes of morbidity and mortality|
|XXI||Z00–Z99||Factors influencing health status and contact with health services|
|XXII||U00–U99||Codes for special purposes|
Approximately 27countries use ICD-10 for reimbursement and resource allocation in their health system, and some have made modifications to ICD to better accommodate its utility. The unchanged international version of ICD-10 is used in 117 countries for performing cause of death reporting and statistics.
The national versions may differ from the base classification in the level of detail, incomplete adoption of a category,or the addition of procedure codes.
Introduced in 1998, ICD-10 Australian Modification (ICD-10-AM) was developed by the National Centre for Classification in Health at the University of Sydney.It is currently maintained by the Australian Consortium for Classification Development.
ICD-10-AM has also been adopted by New Zealand,the Republic of Ireland, Saudi Arabia and several other countries.
Brazil introduced ICD-10 in 1996.
Canada began using ICD-10 for mortality reporting in 2000.A six-year, phased implementation of ICD-10-CA for morbidity reporting began in 2001. It was staggered across Canada's ten provinces, with Quebec the last to make the switch.
ICD-10-CA is available in both English and French language versions.
China adopted ICD-10 in 2002.
The Czech Republic adopted ICD-10 in 1994, one year after official release from WHO. [ citation needed ]As of 2012 [update] [ needs update? ] the Czech Republic has adopted all updates to the international version (namely in 2004, 2010, 2011, 2012).[ citation needed ]The Czech Republic uses the international version without any local modifications.
France introduced a clinical addendum to ICD-10 in 1997.See also website of the ATIH.
Germany's ICD-10 German Modification (ICD-10-GM) is based on ICD-10-AM.ICD-10-GM was developed between 2003 and 2004, by the German Institute for Medical Documentation and Information.
A Korean modification has existed since 2008.
The Dutch translation of ICD-10 is ICD10-nl, which was created by the WHO-FIC Network in 1994.There is an online dictionary.
The Ministry of Healthcare of the Russian Federation ordered in 1997 to transfer all health organizations to ICD-10.
ICD-10 was implemented in July 2005 under the auspice of the National ICD-10 Implementation Task Team which is a joint task team between the National Department of Health and the Council for Medical Schemes.
The current Swedish translation of ICD-10 was created in 1997.A clinical modification has added more detail and omits codes of the international version in the context of clinical use of ICD:
The codes F64.1 (Dual-role transvestism), F64.2 (Gender identity disorder of childhood), F65.0 (Fetishism), F65.1 (Fetishistic transvestism), F65.5 (Sadomasochism), F65.6 (Multiple disorders of sexual preference) are not used in Sweden since 1 January 2009 according to a decision by the present Director General of The National Board of Health and Welfare, Sweden. The code O60.0 (Preterm labor without delivery) is not used in Sweden; instead, since 1 January 2009, the Swedish extension codes to O47 (False labor) are recommended for use.[ citation needed ]
First published in 1998,[ citation needed ] the ICD-10-TM (Thai Modification) is a Thai language version of ICD-10. Maintenance and development of ICD-10-TM is the responsibility of the Thai Health Coding Center (THCC),[ citation needed ] a department of the Thai Ministry of Public Health.[ citation needed ] The current version of ICD-10-TM is based on the 2016 version of ICD-10.[ citation needed ] An unusual feature of the index of ICD-10-TM is that it is bilingual, containing both Thai and English trails.
Along with Czechoslovakia and Denmark; Thailand was one of the first adopters of ICD-10 for coding purposes.[ citation needed ]
ICD-10 was first mandated for use in the UK in 1995.In 2010 the UK Government made a commitment to update the UK version of ICD-10 every three years. On 1 April 2016, following a year's delay, ICD-10 5th Edition replaced the 4th Edition as the mandated diagnostic classification within the UK.
For disease reporting, the US utilizes its own national variant of ICD-10 called the ICD-10 Clinical Modification (ICD-10-CM).A procedural classification called ICD-10 Procedure Coding System (ICD-10-PCS) has also been developed for capturing inpatient procedures. The ICD-10-CM and ICD-10-PCS were developed by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). There are over 70,000 ICD-10-PCS procedure codes and over 69,000 ICD-10-CM diagnosis codes, compared to about 3,800 procedure codes and roughly 14,000 diagnosis codes found in the previous ICD-9-CM.
There was much controversy when the transition from the ICD-9-CM to the ICD-10-CM was first announced in the US. Many providers were concerned about the vast number of codes being added, the complexity of the new coding system, and the costs associated with the transition. The Centers for Medicare and Medicaid Services (CMS) weighed these concerns against the benefits of having more accurate data collection, clearer documentation of diagnoses and procedures, and more accurate claims processing . CMS decided the financial and public health cost associated with continuing to use the ICD-9-CM was too high and mandated the switch to ICD-10-CM.
The deadline for the United States to begin using ICD-10-CM for diagnosis coding and Procedure Coding System ICD-10-PCS for inpatient hospital procedure coding was set at October 1, 2015,a year later than the previous 2014 deadline. Before the 2014 deadline, the previous deadline had been a year before that on October 1, 2013. All HIPAA "covered entities" were required to make the change; a pre-requisite to ICD-10-CM is the adoption of EDI Version 5010 by January 1, 2012. Enforcement of 5010 transition by the Centers for Medicare & Medicaid Services (CMS), however, was postponed by CMS until March 31, 2012, with the federal agency citing numerous factors, including slow software upgrades. The implementation of ICD-10-CM has been subject to previous delays. In January 2009, the date was pushed back to October 1, 2013, rather than an earlier proposal of October 1, 2011.
The examples and perspective in this section may not represent a worldwide view of the subject. (August 2018) (Learn how and when to remove this template message)
The expansion of healthcare delivery systems and changes in global health trends prompted a need for codes with improved clinical accuracy and specificity.The alphanumeric coding in ICD-10 is an improvement from ICD-9 which had a limited number of codes and a restrictive structure. Early concerns in the implementation of ICD-10 included the cost and the availability of resources for training healthcare workers and professional coders.
Two common complaints in the United States about the ICD-10-CM are 1) the long list of potentially relevant codes for a given condition (such as rheumatoid arthritis) which can be confusing and reduce efficiency and 2) the assigned codes for seldom seen conditions (i.e W55.22XA: Struck by cow, initial encounter and V91.07XA: Burn due to water-skis on fire, initial encounter).
Diagnosis-related group (DRG) is a system to classify hospital cases into one of originally 467 groups, with the last group being "Ungroupable". This system of classification was developed as a collaborative project by Robert B Fetter, PhD, of the Yale School of Management, and John D. Thompson, MPH, of the Yale School of Public Health. The system is also referred to as "the DRGs", and its intent was to identify the "products" that a hospital provides. One example of a "product" is an appendectomy. The system was developed in anticipation of convincing Congress to use it for reimbursement, to replace "cost based" reimbursement that had been used up to that point. DRGs are assigned by a "grouper" program based on ICD diagnoses, procedures, age, sex, discharge status, and the presence of complications or comorbidities. DRGs have been used in the US since 1982 to determine how much Medicare pays the hospital for each "product", since patients within each category are clinically similar and are expected to use the same level of hospital resources. DRGs may be further grouped into Major Diagnostic Categories (MDCs). DRGs are also standard practice for establishing reimbursements for other Medicare related reimbursements such as to home healthcare providers.
The Current Procedural Terminology (CPT) code set is a medical code set maintained by the American Medical Association through the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes.
The ICD-10 Procedure Coding System (ICD-10-PCS) is an international system of medical classification used for procedural coding. The Centers for Medicare and Medicaid Services, the agency responsible for maintaining the inpatient procedure code set in the U.S., contracted with 3M Health Information Systems in 1995 to design and then develop a procedure classification system to replace Volume 3 of ICD-9-CM. ICD-9-CM contains a procedure classification; ICD-10-CM does not. ICD-10-PCS is the result. ICD-10-PCS was initially released in 1998. It has been updated annually since that time.
In health care, diagnosis codes are used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnostic coding is the translation of written descriptions of diseases, illnesses and injuries into codes from a particular classification. In medical classification, diagnosis codes are used as part of the clinical coding process alongside intervention codes. Both diagnosis and intervention codes are assigned by a health professional trained in medical classification such as a clinical coder or Health Information Manager.
The International Classification of Health Interventions (ICHI) is a system of classifying procedure codes being developed by the World Health Organization (WHO). It is currently only available as a beta release for additional coding work, and not yet ready for operational application. The last published version is denoted as beta version 2018 The multiaxial classification system has now reached a phase that the testing period for use in healthcare area is approaching during 2018. Updates on development and status of the classification are listed on WHO home page.
The AAPC, previously known by the full title of the American Academy of Professional Coders, is a professional association for people working in specific areas of administration within healthcare businesses in the United States. AAPC is one of a number of providers who offer services such as certification and training to medical coders, medical billers, auditors, compliance managers, and practice managers in the United States. As of October 2018, AAPC has over 175,000 worldwide members, of which nearly 108,000 are certified.
The International Classification of Sleep Disorders (ICSD) is "a primary diagnostic, epidemiological and coding resource for clinicians and researchers in the field of sleep and sleep medicine". The ICSD was produced by the American Academy of Sleep Medicine (AASM) in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society. The classification was developed as a revision and update of the Diagnostic Classification of Sleep and Arousal Disorders (DCSAD) that was produced by both the Association of Sleep Disorders Centers (ASDC) and the Association for the Psychophysiological Study of Sleep and was published in the journal Sleep in 1979. A second edition, called ICSD-2, was published in 2005. The third edition, ICSD-3, was released in 2014.
MEDCIN, a system of standardized medical terminology, is a proprietary medical vocabulary and was developed by Medicomp Systems, Inc. MEDCIN is a point-of-care terminology, intended for use in Electronic Health Record (EHR) systems, and it includes over 280,000 clinical data elements encompassing symptoms, history, physical examination, tests, diagnoses and therapy. This clinical vocabulary contains over 38 years of research and development as well as the capability to cross map to leading codification systems such as SNOMED CT, CPT, ICD-9-CM/ICD-10-CM, DSM, LOINC, CDT, CVX, and the Clinical Care Classification (CCC) System for nursing and allied health.
A clinical coder – also known as clinical coding officer, diagnostic coder, medical coder, nosologist or medical records technician – is a health information professional whose main duties are to analyse clinical statements and assign standard codes using a classification system. The data produced are an integral part of health information management, and are used by local and national governments, private healthcare organizations and international agencies for various purposes, including medical and health services research, epidemiological studies, health resource allocation, case mix management, public health programming, medical billing, and public education.
The Healthcare Cost and Utilization Project is a family of health care databases and related software tools and products from the United States that is developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ).
Current Dental Terminology (CDT) is a code set with descriptive terms developed and updated by the American Dental Association (ADA) for reporting dental services and procedures to dental benefits plans. Prior to 2010 many of the codes were published by CMS as HCPCS D-codes under arrangement with the ADA. Ownership and copyright of CDT remained with the ADA. In 2010 the ADA ended the CMS distribution of CDT codes, which can now be purchased from the ADA.
The Healthcare Common Procedure Coding System is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT).
Intelligent Medical Objects (IMO) is a privately held company specializing in developing, managing and licensing medical vocabularies. IMO partners with various health care organizations, medical content providers and EHR developers.
Nelly Leon-Chisen is the director of coding and classification at the AHA, where she heads the Central Office on ICD-9-CM and the Central Office on HCPCS. She represents the AHA as one of the ICD-9-CM cooperating parties and is responsible for the development of AHA Coding Clinic for ICD-9-CM, ICD-9-CM Official Guidelines for Coding and Reporting, and ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting.
The Protecting Access to Medicare Act of 2014 is a law that delayed until March 2015 a pending cut to Medicare physician payment, a cut that had been regularly delayed for over a decade. Because the law only delayed and did not repeal the physician payment cut, it was a source of controversy.
Clinical documentation improvement (CDI) is the recognized process of improving healthcare records to ensure improved patient outcomes, data quality and accurate reimbursement. The profession was developed in response to the Centers for Medicare and Medicaid Services (CMS) Diagnostic-Related Group (DRG) system, and gained greater notice around 2007.
The International Classification of Diseases (ICD) is the code used for the purpose of documenting a person's medical condition. It is usually important for health insurance reimbursement, administration, epidemiology, and research. Of the approximately 7,000 rare diseases, only about 500 have a specific code. An ICD code is needed for a person's medical records—it is important for health insurance reimbursement, administration, epidemiology, and research. Finding the best ICD code for a patient who has a rare disease can be a challenge.