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ICD-10: How it works and what it means for your specialty practice

By: Nextech | November 19th, 2014

ICD-10: How it works and what it means for your specialty practice Blog Feature

nextech-icd10ICD stands for International Classification of Diseases. This international standard is used to document all different types of diseases and other health-related conditions in many official medical records. Most member states of the World Health Organization (WHO) started using ICD-10 (the most up-to-date version) since 1994. The United States is one of the few WHO members that still uses ICD-9 and has not yet transitioned to ICD-10.

The updated Health Insurance Portability and Accountability Act (HIPAA) mandates that all healthcare providers (as well as clearinghouses and payers) make a complete transition from ICD-9 to ICD-10 for every electronic healthcare transaction by October 1, 2015. If ICD-10 isn’t implemented by that date, your insurance claims and overall practice collections will take a major hit. In other words, you won’t be reimbursed for what is rightfully yours if you submit insurance claims using ICD-9 codes for medical treatment on or after October 1, 2015.

Our advice: Don’t wait until the last minute. Start preparing for ICD-10 now so you don’t miss a beat after the deadline. With that in mind, we wanted to provide the brass tacks on ICD-10 and inform you of how Nextech can you help you with a seamless transition.

How is ICD-10 different from ICD-9?

ICD-10 yields much greater specificity and detail of the patient’s medical condition than ICD-9, such as:

  • Types of complications,
  • Degree of severity and risk,
  • Precise character of the injury, illness, or abnormality,
  • Comorbidities
  • Many other health-related parameters.

In the United States, ICD-10 breaks down into two major categories: ICD-10-CM and ICD-10-PCS. ICD-10 doesn’t apply to the Current Procedural Terminology (CPT) coding for outpatient procedures.

ICD-10-CM: Created by the Center for Disease Control and Prevention, ICD-10-CM (clinical modification) is a diagnosis classification system comprised of about 70,000 codes. Although the code format is virtually the same between the two versions, ICD-10-CM increased the number of characters in a single code from 3 to 7 compared to ICD-9-CM’s 3 to 5 characters per code.

ICD-10-PCS: The Centers from Medicare and Medicaid Services (CMS) established the ICD-10-PCS (Procedure Coding System) for use in U.S. inpatient hospitals only, meaning it’s not a component of the International Standard. ICD-10-PCS expanded its number of alphanumeric characters per code to seven, as opposed to 3 or 4 digits in ICD-9-PCS. The total number of ICD-10-PCS codes amounts to 72,000, and each one is significantly more detailed and different in its format from ICD-9-PCS codes.

An example of the difference between ICD-9 and ICD-10

Let’s take an example of a woman with a fractured femoral shaft. The ICD-9-CM code and description for this injury reads as follows:

“821.11 – Open fracture shaft of femur.” (Source: AAPC,

In ICD-10-CM, the code and description for the exact same injury reads as follows:

“S72.351C – Displaced comminuted facture of the right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC.” (Source: AAPC,

This example illustrates that the level of detail in ICD-10 is much greater and thus more relevant to this particular injury compared to ICD-9. Further, there are 16 codes for the variations to a fractured femoral shaft in ICD-9 and 1530 total codes to fully encompass all of the variations in 1CD-10.

How will ICD-10 affect your specialty practice?

Due to the acutely precise representation of the severity and complexity related to a particular medical condition, ICD-10 codes will prevent any ambiguity by accurately translating your documentation into more clinically relevant codes. Therefore, ICD-10 can influence the accuracy of your billing when you file an insurance claim, as well as overall healthcare statistics, analytics, and research; population and risk management; and most importantly, patient care. You will be able to choose from over 140,000 codes (compared to ICD-9’s 18,000 codes) that are classified into:

  1. Epidemic diseases
  2. Constitutional or general diseases
  3. Developmental diseases
  4. Injuries
  5. Local diseases ranged by site (Codes can also be organized by a very specific area of the body, such as a code set for the ear and another one for the mastoid process)

Due to the sheer number of ICD-10 codes, it might seem like a daunting task to try to memorize them all. A thorough review of the most frequent diagnoses in your specialty practice can help you narrow down which sets of ICD-10 codes you should focus on and start from there.

Nextech has built a robust, integrated ICD-10 solution that allows users to keep their familiar workflow while learning new codes through the use of GEMS crosswalks, spawning, smart stamps, and search features. As always, Nextech is dedicated to upgrading and training its clients, so they can begin using ICD-10 ahead of schedule.

If you have any questions or would like to find out more about how Nextech can assist you in your transition to ICD-10, call us at 1-866-856-0784 now!

Download the whitepaper and get ready for ICD-10!