July 24, 2012

Government Posts ICD-10-CM Updates

By Beth Parker-Garza, RHIT, CCS, CRCR

Analysts from the Centers for Medicare & Medicaid Services (CMS) continue to review the public comments received on the proposed implementation delay of ICD-10 system.

At this time, it’s unknown when the agency will issue a final rule, but preparations for the new system continue, and 2013 files for the diagnosis and procedure code sets have been issued. Although these updated versions are now available for public viewing, the codes are not, of course, currently valid for any purpose or use.

Still assuming an October 1, 2013, effective date for the implementation of the ICD-10-CM diagnosis and ICD-10-PCS systems, the government agencies that posted the updates—the Centers for Disease Control (CDC) and CMS—announced that they expect still more revisions before the actual implementation date.

What’s New?

Although the National Center for Health Statistics (NCHS) is responsible for development of the diagnosis code set, under authorization of the World Health Organization (WHO), some of the files are now available at the CDC’s website (http://www.cdc.gov/nchs/icd/icd10cm.htm#10update) These files (in PDF and XML), which include the following, update the December 2011 version of the code set.

  • Index to Diseases and Injuries
  • External Cause of Injuries Index
  • Table of Drugs and Chemicals
  • Table of Neoplasms
  • Tabular List of Diseases And Injuries

Revisions made to ICD-10-CM are shown in the addenda files, and those changes have been incorporated into comprehensive files. However, note that the coding guidelines are not yet available.

The preface provides an overview of how the U.S. version of the ICD-10-CM differs from the original WHO version. Specifically, it is a clinical modification whose intent is to serve as a tool in the area of classification of morbidity data for indexing of medical records, medical care review, and ambulatory and other medical care programs, as well as for basic health statistics. To describe the patient’s clinical picture, the codes must be more precise than those needed only for statistical groupings and trend analysis.

General Equivalence Mappings (GEMs)

Also posted by the CDC are the updated fiscal year (FY) 2013 GEMs for public comment. The agency noted that it has incorporated all changes received from the public and internal reviewers. The types of changes include the following:

  • Added entries for the new FY 2013 codes: NCHS expanded the codes for pseudoexfoliation glaucoma, adding added 20 new glaucoma codes.
  • Expanded cluster translations for completeness: For completeness, codes specifying the insertion of a lead into the coronary vein and right atrium were added to the cluster translation of the ICD-9 codes.
  • Revised entries to better meet inclusion criteria: GEMs entries for codes specifying forceps operations with episiotomy do not need to include the repair of perineum in the target cluster. According to ICD-10-PCS guideline B3.1b, procedural steps necessary to close the operative site are not coded separately.

Two documentation guides are included in the GEMs files: one for general users and one for technical users. The technical guide, for example, discusses translation rules for obstetrics and angioplasty, describes GEMS flags in detail, specifies GEMS entry inclusion criteria, and provides examples.

Next Steps

Part of the daily work of health information management (HIM) professionals is to deal successfully with changes and updates like these and to remain flexible during these times.  As always, it is important to review the updates, and understand what they mean to your work, facility, and/or practice.

Remember, as we draw nearer to the implementation deadline:

  • Be proactive.
  • Communicate with, and educate, coders and physicians.
  • Keep your eyes and ears open for more updates.

About the Author

Beth Parker-Garza is Vice President, Clinical Division-HIM, MedLearn Publishing, a division of Panacea Healthcare Solutions, St. Paul, MN.

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