# Presentation: 174175

## The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical ModificationOffice of the Center Director, Data Policy and Standards National Center for Health StatisticsDonna Pickett, MPH, RRA 

**CDC**
- Centers for Disease Control and Prevention

**nchs**

## ICD-10 Evaluation Contract

- Assess whether ICD-10 significant improvement over ICD-9-CM to warrant implementation for morbidity reporting
- Recommend additional improvements to ICD-10 and to correct any problems identified during the course of evaluation.
- Develop a revised alphabetic index and a crosswalk to ICD-9-CM

## Contract Findings

- ICD-10 not significantly better than          ICD-9-CM for morbidity applications to warrant implementation.
- A clinical modification of the ICD-10 would be a significant improvement and worth implementing.

## Why a Clinical Modification ?

- Need to:
- remove codes unique to mortality coding
- remove procedure codes included with diagnosis codes
- remove “multiple” codes (e.g., S69.7, multiple injuries of wrist & hand)
- combine the dagger and asterisk codes

## Phase IICreating the Clinical Modification

- Further evaluation of ICD-10 categories to provide codes for ambulatory and managed care encounters, clinical decision-making and outcomes research
- Evaluation of residual categories (“Other Specified”) to determine whether further specificity is needed

## Phase II Focused Reviews

- Review of previous Coordination and Maintenance Committee recommendations that could not be incorporated into ICD-9-CM due to space limitations
- Consultation with physician groups and others to assure clinical accuracy

## ICD-10-CMMajor   Modifications

- Addition of sixth character
- Incorporation of common 4th and 5th digit subclassification
- Addition of Laterality
- Combining dagger/asterisk codes

## ICD-10-CMMajor Modificationscontinued

- Created combination diagnosis / symptoms codes
- Deactivated procedure codes
- Further expansion of post-operative complication codes

## Injury codes in ICD-9-CM/ICD-10

**Open wounds**
- laceration w/foreign body
- laceration w/o foreign body
- puncture wound w/foreign body
- puncture wound w/o foreign body
- bite

**Superficial wounds**
- abrasion
- blister
- contusion
- external constriction
- superficial foreign body
- insect bite

## ICD-10-CMExpanded Injury Codes

- Detail for open wounds added at 5th digit
- S41.0_1_ Laceration of shoulder without 		foreign body
- S41.0_2_  Laceration of shoulder with 		foreign body
- S41.0_3_  Puncture wound of shoulder 		without foreign	body

## Injury CodesExpanded Injury Codes

- S00.411  Abrasion of ear, right ear
- S50.351  Superficial foreign body of        		right elbow
- S81.012  Laceration without foreign 		body, left knee

## ICD-10-CMExpanded Injury Codes

- Laterality added at 6th digit
- S41.01_1_ Laceration of shoulder without 		foreign body, right shoulder
- S41.02_2_  Laceration of shoulder with 		foreign body, left shoulder
- S41.03_2_  Puncture wound of shoulder 		without foreign	body, left 			shoulder

## Injury codes in ICD-10-CM

**Confirmed abuse**
- T74.02 Child neglect or 	abandonment
- T74.12 Child physical abuse
- T74.22 Child sexual abuse
- T74.32 Child psychological 	abuse

**Suspected abuse**
- T76.02 Child neglect or abandonment, suspected
- T76.12 Child physical abuse, suspected
- T76.22 Child sexual abuse, suspected
- T76.32 Child psychological abuse, suspected

## Poisonings

- T39.0 Poisoning by salicylates
- 	T39.00 Poisoning by salicylates, 				undetermined intent
- 	T39.01 Poisoning by salicylates, 				accidental (unintentional)
- 	T39.02 Poisoning by salicylates, 				intentional self-harm
- 	T30.03 Poisoning by salicylates, 				assault

## PoisoningsCarbon Monoxide

- T58.0 Toxic effect of carbon monoxide from 	motor vehicle exhaust
- 	T58.00 Toxic effect of carbon monoxide from motor 		vehicle exhaust, undetermined intent
- 	T58.01 Toxic effect of carbon monoxide from motor 		vehicle exhaust, accidental (unintentional)
- 	T58.02 Toxic effect of carbon monoxide from motor 		vehicle exhaust, intentional self-harm
- 	T58.03 Toxic effect of carbon monoxide from motor 		vehicle exhaust, assault

## PoisoningsCarbon Monoxide- cont’d

- T58.1x   Toxic effect of carbon monoxide 		from utility gas
- T58.2x   Toxic effect of carbon monoxide 		from incomplete combustion of 		other domestic fuels
- T58.8x    Toxic effect of carbon monoxide 		from other source
- T58.9x     Toxic effect of carbon monoxide 		from unspecified source
- .

## ICD-10-CMExpanded External Cause  Codes

- Y07.11 Biological father as perpetrator 		of maltreatment and neglect
- Y07.13  Adoptive mother as perpetrator 		of maltreatment and neglect
- Y07.410 Brother as perpetrator of 			maltreatment and neglect
- Y07.420	Foster father as perpetrator

## Place of Occurrence

- Y92.0xx 	Non-institutional (private) residence
- Y92xx 	Institutional (non-private) residence
- Y92.2xx	School, other institution
- Y92.3xx	Sports and athletics area
- Y92.4xx	Street and highway
- Y92.5xx	Trade and service area
- Y92.6x	Industrial and construction area
- Y92.7x	Farm
- Y92.8xx	Other specified place

## Place of OccurrenceExamples

- Y92.0 Non-institutional (private) residence
-     Y92.01  Single-family non-institutional 		(private) house
- 	Y92.010  Kitchen
- 	Y92.012  Bathroom
- 	Y92.016  Swimming pool

## Activity

- Y93.0xx  	Injured while engaged in sports 				activity
- Y93.1xx  	Injured while engaged in leisure 				activity
- Y93.4  	Injured while resting, sleeping, eating 		or engaging in other vital activities
- Y93.8  	Injured while engaged in personal 				hygiene
- Y93.9  	Injured during unspecified activity

## ActivityExamples 

- Y93.0 Injured while engaged in sports activity
-     Y93.01x	 Individual school sports activity
-      Y93.02x  Non-school sports activity
-      Y93.03x	  Individual military sports activity
-      Y93.04x	  School group sports activity
-       Y93.05x  Non-school sports activity
-       Y93.06	   Military group sports activity

## ICD-10-CMExpanded Injury /External Cause Codes

- Extensions added to Injury and External Cause chapters
- A	initial encounter for treatment of 	injury
- B	subsequent encounter for 	treatment 	of injury

## ICD-10-CMNext Steps

-  Complete review of contractor's report and  recommendations
-  Finalize Tabular List revisions
-  Revise Index & Crosswalks
-  Revise guidelines
-  Develop training materials
-  Testing
-  Comparability study
-  Additional tools:  database version

## ICD-10-CM Testing

- CDACs: 3,000 medical records
- NCHS contractor: several hospitals (inpatient and outpatient)
- Other testing: AHA, AHIMA and others will also test

## HIPAA and ICD-10-CM Implementation

- Implementation of ICD-10-CM is tied to the standards adoption process specified in the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

## HIPAA and ICD-10-CM Implementation

- The Administrative Simplification (AS) provisions of HIPAA are intended to reduce the costs and administrative burdens of health care by making possible the standardized, electronic transmission of many administrative and financial transactions that are currently carried out manually on paper.

## Administrative Simplification Provisions of HIPAA

- Outlines national framework for:
- Electronic data interchange
- Health data standards
- Health Information privacy
- Improving efficiency and effectiveness of health care system

## New Code sets Under HIPAA

- No decisions have been made regarding new code sets
- NPRM advised those who produce and process data to anticipate changes and build in system flexibility to allow implementation of different formats
- Any recommendation for new standards requires public hearings & new NPRM

## Web Sites

- 	_NCHS Classification of Diseases_:
**Information about ICD-9-CM and ICD-10-CM**
**     ****http://www.cdc.gov/nchs/icd9.htm**
**         **
- _Administrative Simplification_
**Frequently Asked Questions**
**http://aspe.os.dhhs.gov/admnsimp/**