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ICD-9-CM vs. ICD-10-CM Comparison

Chapter Differences

Glossary of ICD-10 Terms

Code Groupings and Codes

• category - The first three characters of both ICD-9-CM and ICD-10-CM diagnosis codes.
• subcategory - Additional characters beyond the category of ICD-9-CM and ICD-10-CM diagnosis codes.
• placeholder - The character X is inserted to hold the places of the 5th or 6th character in codes with six or seven characters if there is not a 5th or 6th character.

Code Description Terms

• and - Means "and/or" when it appears in a title or narrative statement.
• with - Term used in the alphabetic index immediately following the main term, but not necessarily in alphabetic order.
• includes - Term that is accompanied by conditions that are examples of what may be included in a specific category.
• see - Term used to instruct the coder to refer to another term.
• see also - Term used to instruct the coder to refer to another term.
• code also - Instruction that tells the coder that more than one code must be assigned, but it does not imply any sequencing guidance.
• code first - Instructs the coder to assign the code for the underlying disease before the code for the manifestation of the disease and generally accompanies a manifestation code.
• Not Elsewhere Classifiable - (NEC) May be interpreted as "other specified"; codes with this abbreviation are assigned when there is more specific documentation but no code exists for the appropriate level of specificity.
• Not Otherwise Specified - (NOS) Another way of stating "unspecified"; codes with this abbreviation are assigned when more specific codes may exist but the documentation lacks specificity.

Code Description Punctuation

• brackets [ ] - Punctuation found in both the tabular list and the alphabetic index surrounding manifestation codes to indicate that the manifestation should be sequenced after the disease code.
• parentheses ( ) - Punctuation found in both the tabular list and the alphabetic index that surrounds nonessential modifiers.
• nonessential modifiers - Terms that may coexist with the main term but do not change the code assignment for the condition.
• colon : - Punctuation found in the tabular list when a term must be modified by the addition of another term in order to qualify it for assignment of a specific code or to a category.

Excludes vs. Excludes1 and Excludes2

"Excludes" as used in ICD-9-CM indicates that the code should not be used, because another code may be more appropriate. "Excludes" notes usually include suggestions of more appropriate codes or code ranges.

ICD-10-CM introduces two types of excludes: "Excludes1" and "Excludes2".

Codes/conditions listed in the "Excludes1" notes should not be used because the two conditions do not occur together.

Codes/conditions listed in the "Excludes2" notes indicate that the conditions being excluded are not considered part of the subject condition, but that another code should also be assigned.

Codes may have both, either or neither Excludes1 and Excludes2 notes.

Other ICD-10 Terms

• Acute Conditions - The medical conditions characterized by sudden onset, severe change, and/or short duration.

• Additional Diagnosis - The secondary diagnosis code used, if available, to provide a more complete picture of the primary diagnosis.

• Bilateral - For bilateral sites, the final character of the codes in the ICD-10-CM indicates laterality. An unspecified side code is also provided should the side not be identified in the medical record. If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.

• Chronic Conditions - Medical conditions characterized by long duration, frequent recurrence over a long period of time, and/or slow progression over time.

• Combination Codes - A single code used to classify any of the following: two diagnoses; a diagnosis with an associated secondary process (manifestation); or a diagnosis with an associated complication.

• Crosswalk/mapping - A new test is determined to be similar to an existing test, multiple existing test codes, or a portion of an existing test code. The new test code is then assigned to the related existing local fee schedule amounts and resulting national limitation amount. In some instances, a test may only equate to a portion of a test, and, in those instances, payment at an appropriate percentage of the payment for the existing test is assigned.

• GEMs - This reference mapping attempts to include all valid relationships between the codes in the ICD-9-CM diagnosis classification and the ICD-10-CM diagnosis classification.

• Manifestation Codes - Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.

• Medical Necessity - Services or supplies that: are proper and needed for the diagnosis or treatment of a medical condition; are provided for the diagnosis, direct care, and treatment of a medical condition; meet the standards of good medical practice in the local area; and are not mainly for the convenience of the patient or doctor.

• Morbidity - Term refers to the disease rate or number of cases of a particular disease in a given age range, gender, occupation, or other relevant population based grouping.

• Mortality -Term refers to the death rate reflected by the population in a given region, age range, or other relevant statistical grouping

• Principle Diagnosis - First-listed/primary diagnosis code. The code sequenced first on a medical record defines the primary reason for the encounter as determined at the end of the encounter.

• Signs/Symptoms - Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider.

• Sequelae - A late effect is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a late effect code can be used. The residual may be apparent early, such as in cerebral infarction, or it may occur months or years later, such as that due to a previous injury.

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