The imminent transition from ICD-9 to ICD-10 tends to generate strong opinions. When the Centers for Medicare & Medicaid Services delayed ICD-10 implementation to October 1, 2015, some viewed it as a positive while others saw the move as a negative.
No matter what your opinion, there’s no denying ICD-10 will usher in more diagnosis codes than ICD-9. CMS estimates about 68,000 ICD-10 codes will go into effect October 1, 2015 (compared to about 13,000 ICD-9 diagnosis codes in use today).
It’s not just the greater number of codes — ICD-10 increases specificity in most instances, and with that comes greater complexity. This means some specialties could experience a more difficult transition than others. Cardiology, nephrology and neurology, for example, could face drastic changes to some of their most common codes.
ICD-10 Codes for Cardiologists
If you’re a cardiologist, not only will you be dealing with code changes, but you face some definition changes as well. In ICD-10, the acute phase of myocardial infarction changes from 8 weeks to 4 weeks. Sticking with the former definition can create a miscode.
Also, CMS removes some codes specifying episodes of care. For example, the ICD-9 code 410.00 for AMI of the anterolateral wall is “for an unspecified episode of care.” This converts to I21.09 in ICD-10, which doesn’t address episodes of care at all.
Also watch for new combination codes. For example, atherosclerotic heart disease of the native coronary artery with angina pectoris requires two separate codes in ICD-9, but in ICD-10 only takes the single combination code I25.11.
ICD -10 Codes for Nephrologists
Relearning the codes for various types of chronic kidney disease (CKD) could be the toughest challenge to nephrologists. This is because of the high number of those affected in the United States — the National Kidney Foundation estimates 26 million adults have CKD.
Nephrologists also will need to use multiple codes for diabetic CKD. One code indicates the type of diabetes with CKD and the other indicates the stage of CKD, for example. In addition, one ICD-9 diabetes code becomes five in ICD-10.
Acute Renal Failure Unspecified translates directly from ICD-9 code 584.9 to ICD-10 N17.9. But ICD-10 will require more information on type and origin of acute renal failure. For example, ICD-10 requires more precision to distinguish among acute renal failure with tubular necrosis, acute cortical necrosis or medullary necrosis, according to Precyse, CareCloud’s ICD-10 physician education partner.
ICD-10 Codes for Neurologists
Some of the most common ICD-9 neurology diagnosis codes become more specific (or more complicated, depending on how you look at it) with the ICD-10 coding system, according to the American Academy of Neurology.
For many common conditions, neurologists will see a one-to-one conversion of a general condition code. For example, Alzheimer’s disease moves from ICD-9 code 331.0 to ICD-10 code G30.9 Alzheimer’s disease, Unspecified. After that, ICD-10 gets more complex. For Alzheimer’s disease, ICD-10 offers 3 new coding options: G30.0 Alzheimer’s disease with early onset; G30.1 Alzheimer’s disease with late-onset; and G30.8 Other Alzheimer’s disease.
The same pattern emerges with organic sleep apnea — 327.20 Organic Sleep Apnea, Unspecified becomes G47.30 Sleep Apnea, Unspecified under ICD-10. So far, so good. But then CMS adds 8 more ICD-10 codes, including specific codes for G47.31 Primary Central Sleep Apnea, G47.33 Pediatric/Adult Obstructive Sleep Apnea and G47.34 Idiopathic Sleep-Related Nonobstructive Alveolar Hypoventilation.
Migraines ICD-10 codes, similarly, gain complexity. For example, ICD-9 code 346.90 ‘Migraine, Unspecified, Without Mention of Intractable Migraine Without Mention of Status Migrainosus’ becomes ICD-10’s G43.909 ‘Migraine, Unspecified, Not Intractable, Without Status Migrainosus.’ But CMS provides ten additional ICD-10 codes in this category, including:
G43.109 Migraine with Aura, Not Intractable, Without Status Migrainosus
G43.409 Hemiplegic Migraine, Not Intractable, Without Status Migrainosus
G43.829 Menstrual Migraine, Not Intractable, Without Status Migrainosus
Wondering what will your favorite ICD-9 code might look like in the ICD-10 system? Plug it into the ICD-9 to ICD-10 Code Converter (which converts codes from ICD-10 back to ICD-9 too).
Regardless of your specialty, preparing now for ICD-10 changes could decrease disruptions in productivity and cash flow come ICD-10 implementation time.
Salvador Lopez contributed to this post.
