What is defined in an ICD-10 code?
ICD-10 codes allow doctors to specifically define diseases, signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injuries and diseases. There is a heightened level of specificity to ICD-10 which is reached through detailed documentation.
What is ICD-10’s code structure?
In ICD-10-CM (Clinical Modification), the codes structure is as follows:
The code is 3-7 characters long. The first character is an alpha character (other than “U”). The second character is numeric. These two first characters together describe the code’s category. Characters 3-7 can be any combination of alpha or numeric characters. They describe the etiology, anatomical site, and severity of the codes, while character 7 serves as an extension code, if needed. A decimal is placed after the third character.
For ICD-10-PCS (Procedure Coding System), the code structure is as follows:
The code is 7 alphanumeric characters long. The first character identifies the section or type of procedure. The second character identifies the body system or anatomical region the procedure is taking place in. The third character identifies the root operation or objective of the procedure. Character four identifies the body part or specific anatomical site of the procedure. Character five identifies the approach or technique used during the procedure. The sixth character identifies any devices left at the operative site, and character seven identifies qualifiers for any additional information. As not all procedures involve leaving devices at the operative site and there will not always be additional information, characters six and seven can be filled in with a Z. There are no decimals in ICD-10-PCS codes.
Doesn’t identify right versus left.
Identifies right versus left >40% of codes.
Codes are 3-5 digits
No placeholder characters
69,000 codes to better capture specificity
Limited Severity Parameters
Extensive Severity Parameters
Limited Combination Codes
Extensive Combination Codes to better capture complexity
1 type of Excludes Notes
2 types of Excludes Notes
Limited available space for new codes
Flexibility to add new codes
Ambiguous overall detail embedded within codes
Very specific detail embedded within codes (Allows description of comorbidities, manifestations, etiology/causation, complications, detailed anatomical location, sequelae, degree of functional impairment, biologic and chemical agents, phase/stage, lymph node involvement, lateralization and localization, procedure or implant related, age related, or joint involvement)
Sample code: 813.15, Open fracture of head of radius
Sample code: S52123C, Displaced fracture of head of unspecified radius, initial encounter for open fracture type IIIA, IIIB, or IIIC
Sources: ICD-10 Implementation Guide for Small and Medium Practices & Road to 10
ICD-9 Procedure Codes
3-4 numbers in length
7 alpha-numeric characters in length
Approximately 3,000 codes
Approximately 87,000 available codes
Based on outdated technology
Reflects current usage of medical terminology and devices
Limited space for adding new codes
Flexible for adding new codes
Generic terms for body parts
Detailed descriptions for body parts
Lacks descriptions of methodology and approach for procedures
Provides detailed descriptions of methodology and approach for procedures
Lacks precision to adequately define procedures
Precisely defines procedures with detail regarding body part, approach, any device used, and qualifying information