Icd-9/10 Codes Cheat Sheet printable pdf download

ICD-9/10 Codes Cheat Sheet

History

ICD-10 was created by the World Health Organization in 1992 and is utilized by 25+ countries today as a diagnostic and procedure classification tool. The US version of

ICD-10 has been clinically modified and is scheduled to be implemented on October 1, 2015.

Enforcement

Claims: CMS is mandating ICD-10 codes be submitted on all claims with dates of service / discharge dates on or after 10/1/2015.

Authorizations: Applies to diagnosis codes only. ICD-10 diagnosis codes will be accepted on prior authorization requests submitted 7/1/2015 or later for services with

a start date on or after 10/1/2015. ICD-9 codes will no longer be accepted on prior authorization requests submitted on 10/1/2015 or later except in the case of retro

authorizations for services with a start date on or before 9/30/2015.

All applications should retain the ability to accept/process/store ICD-9 codes after the compliance date as a risk mitigation measure. There is a possibility external

entities may not be ready for the ICD-10 transition.

Rationale for Change



ICD-9 codes do not allow for greater detail -> ICD-10 codes provide for a greater level of specificity



ICD-9 code categories are inconsistent with current medical practice -> ICD-10 codes allow for greater categorization of codes



ICD-9 codes use outdated and obsolete terminology -> ICD-10 codes have enhanced definitions

Benefits of Change

Greater specificity and code applicability allow for advances in:



Measuring quality, safety, and efficacy of care



Designing payment systems



Processing claims



Making clinical decisions



Tracking public health



Identifying fraud and abuse



Conducting research, epidemiological studies, and clinical trials

Number of Codes

ICD-9

ICD-10

Diagnosis

~14,000 ICD-9 CM codes

~69,000 ICD-10 CM codes

Procedure

~3,800 ICD-9 CM codes

~72,000 ICD-10 PCS codes

Updates to the code-set are published annually and as needed to address acute coding needs.

Length

ICD-9

ICD-10

Diagnosis

3-5 alphanumeric characters

3-7 alphanumeric characters

Procedure

3-4 numeric characters

Up to 7 alphanumeric characters

Decimal Point Usage

ICD-9

ICD-10

Diagnosis

After 3

digit

After 3

digit

Procedure

After 2

digit

No decimal points

Decimal points are occasionally used in ICD-9/10 documentation. Decimal points are not used in AMISYS but are used in TruCare.

Structure

ICD-9

ICD-10

Diagnosis

First 3 characters designate the category of diagnosis (Ex.

First 3 characters designate the category of diagnosis (Ex. Injury of

Injury of muscle, fascia and tendon at lower leg)

muscle, fascia and tendon at lower leg)

Next 2 characters designate other vital details – etiology,

Next 3 characters designate other vital details – etiology, anatomic site,

anatomic site, manifestation (Ex. Strain of right Achilles

manifestation (Ex. Strain of right Achilles tendon)

tendon)

character designates initial encounter, subsequent encounter, or

sequela

Some codes utilize a placeholder ‘X’ for certain digits

Procedure

character is category (Ex. Respiratory system)

character is the name of section (Ex. Medical and Surgical Section)

character is significant axis (Ex. Lung and Bronchus)

character is body system (Ex. Lower joints)

character is etiology or disease manifestation (Ex.

character is root operation (Ex. Replacement)

Diagnostic procedures)

character is body part (Ex. Knee joint, right)

character is sub-classification (Ex. Open biopsy of lung)

character is approach (Ex. Open)

character is device (Ex. Synthetic substitute)

character is qualifier (Ex. Diagnostic)

Some codes utilize a placeholder ‘X’ for certain digits

Claim Specifics

Institutional Claims / 837I*

Professional Claims / 837P**

ICD Indicator / Qualifier

Yes

25 codes maximum (inclusive of Principal),

12 codes maximum (1

listed is Principal),

Diagnosis Codes

25 POA indicators

No POA indicators

Admit Diagnosis Code

1 code maximum

N/A

Patient Reason for Visit

3 codes maximum

N/A

Diagnosis Codes

External Cause of Injury

12 codes maximum,

N/A

Diagnosis Codes

12 POA indicators

ICD Procedure Codes

25 codes maximum (inclusive of Principal)

N/A, just CPT/HCPCS codes

Service Line Diagnosis

There can be up to 50 service lines on the claim, each service line can point

N/A, pointers not used for institutional claims

Code Pointers

at up to 4 diagnosis codes

* CMS-1450 (Institutional Paper Claim Form) differences: 18 diagnosis codes maximum, 3 ECI diagnosis codes, 6 ICD procedure codes

** CMS-1500 (Professional Paper Claim Form) differences: 6 service lines on the claim

Icd-9/10 Codes Cheat Sheet

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