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What’s The Key Difference Between ICD-9 & ICD-10?

August 19, 2015

There is one key difference between ICD-9 and ICD-10, Vision Source’s Navigation Guide to Health Care Reform notes. Under ICD-9, the coder was supposed to specifify laterality or bilaterality using modifiers. The major change is that in ICD-10, laterality or bilaterality is a part of the base code, instead of needing a modifier.

ICD-10 is not just an update of ICD-9. There are fundamental changes in the ICD-10 codes from the ICD-9 codes. There are problems with the ICD-9 codes that the ICD-10 codes fix.

One of the major problems with ICD-9 is the lack of specificity. Modifiers need to be used in ICD-9 to convey if it is a right-side problem, left-side problem or both sides problem. ICD-10 fixes that by introducing within the base code the laterality. ICD-10 doesn’t stop with just right eye, left eye, and both eyes; it adds “unspecified eye.” Yes, people sat around a table and came up with that last one. (By the way, don’t ever use the unspecified eye code ever!)

Here’s an example of the lack of specificity with the diagnosis of myopia. Under ICD-9, myopia’s code is 367.1. It is the same if it is the right eye, the left eye, or both eyes. Under ICD-10, myopia has four codes:

H52.10 Myopia, unspecified eye
H52.11 Myopia, right eye
H52.12 Myopia, left eye
H52.13 Myopia, bilateral

The same is true for ocular hypertension. Under ICD-9, ocular hypertension’s code is 365.04. It is the same if it is the right eye, the left eye, or both eyes. Under ICD-10, ocular hypertension has four codes:

H40.051 Ocular hypertension- right eye
H40.052 Ocular hypertension- left eye
H40.053 Ocular hypertension- bilateral
H40.059 Ocular hypertension- unspecified eye

Another problem in the ICD-9 code set is that some of the chapters are full. There is no more room for new codes. ICD-10 fixes that problem by increasing the character lengths. This makes it less likely that ICD-10 will run out of codes in the future. To clarify this point, ICD-9 is comprised of codes that are 3-5 characters in length for about 13,000 codes. ICD-10 is comprised of codes that are 3-7 characters in length for about 68,000 codes. Extra characters permit extra codes.

Even though the codes are different, the basic principles you are using now to code glaucoma are very similar. With glaucoma you still have to “stage” the glaucoma in both ICD-9 and ICD-10. Here are the low tension glaucoma codes for the right eye for ICD-10:

H40.1210 …… Low-tension glaucoma, right eye, stage unspecified
H40.1211 …… Low-tension glaucoma, right eye, mild stage
H40.1212 …… Low-tension glaucoma, right eye, moderate stage
H40.1213 …… Low-tension glaucoma, right eye, severe stage
H40.1214 …… Low-tension glaucoma, right eye, indeterminate stage

With glaucoma, you must code the type of diabetes – Type 1 or Type 2 – the kind of retinopathy and the “stage,” plus the presence or absence of macular edema. Here are the Type 2 diabetes mellitus with nonproliferative diabetic retinopathy codes:

E11.321 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
E11.329 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema
E11.331 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
E11.339 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema
E11.341 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema
E11.349 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema

Trauma is the hardest thing to code in ICD-10. First, you code the eye problem, then you code where the accident happened, what the activity was at the time, what the injury was, and what the other injuries occurred. Because of the complication level of trauma, we will explore this in depth in later ROB articles.

Today, you need to make sure you have these three steps in place:

1. Make sure you have the software that will help you code ICD-10. The software is the key. The books make this transition too difficult.
2. Make sure you have tested your software and understand how to use it to code ICD-10.
3. Make sure you understand how to code the conditions of glaucoma, diabetes and trauma using the ICD-10 codes.

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