Presentation-Comparative Analysis Of ICD-10-CM With ICD-11 .
NCVHS Full Committee Meeting March 31, 2021Comparative Analysis of ICD-10-CM withICD-11 for Morbidity CodingKin-Wah FungDonna PickettJulia XuShannon McConnell-LampteyOlivier BodenreiderNational Library of Medicine,National Institutes of HealthNational Center for Health Statistics,Centers for Disease Control and Prevention1
Background ICD-11 adopted by the World Health Organization(WHO) in May 2019, will be implemented from January2022 In the US, we have been creating our own extensioncalled Clinical Modification (ICD-9-CM, ICD-10-CM) formorbidity coding, because the international core is notprecise enough to describe the clinical details What’s new in ICD-11 40% bigger than ICD-10 (4,000 more codes) Supports postcoordination (over 14,500 extension codes) Is a Clinical Modification still necessary?a U.S. National Library of Medicine2
Research topics the Committee recommends include:Whether ICD-11 can fully support morbidityclassification in the U.S. without development of aU.S. clinical modification (CM) and if not, are thereareas to be targeted in a CM version. Development ofa U.S. clinical modification for morbidity extends theimplementation timetable and requires additionalongoing processes for curation of the classification.3
Research method Identify the most commonly used ICD-10-CM codes Recode the ICD-10-CM codes in ICD-11 to assesscoverage and level of equivalence Review coding guidance to look for subtle differences inthe meaning of codesa U.S. National Library of Medicine4
Most commonly used ICD-10-CM codes Medicare claims are one of the biggest collections of ICD-10-CMcodes in use Medicare claims data have been made available to researchersthrough the CMS Virtual Research Data Center However, Medicare patients are mostly 65 and so missing codesfrom 3 chapters Chapter 15 Pregnancy, childbirth and the puerperium Chapter 16 Certain conditions originating in the perinatal period Chapter 17 Congenital malformations, deformations and chromosomalabnormalities Alternative source of ICD-10-CM codes for these 3 chapters:University of Nebraska Medical Center (thanks to James Campbelland Ellen Kerns) All data are aggregate data and deidentifieda U.S. National Library of Medicine5
Medicare claims: Jan – Dec 2017 61 million unique Medicarepatients; 28,981 unique ICD10-CM codes ICD-10-CM codes as principalor secondary diagnosis (exceptchapters 15,16 & 17)Nebraska University Medical Center Oct 2015 – Mar 2020 778,000 unique patients, 23,832unique ICD-10-CM codes ICD-10-CM codes as principalor secondary diagnosis fromchapters 15,16 & 17Most frequently used codes in eachchapter covering 60% of uniquepatients: 962 ICD-10-CM codes19 obsolete ICD-10CM codes excludedfrom study943 ICD-10-CM codes6
ChapterCode rangeTotal no. of codes inchapter1058Top codes (60%usage)19Top codes as % ofchapter1.8%16612516654.0%2.0%1A00-B99 Certain infectious and parasitic diseases23C00-D49 NeoplasmsD50-D89 Diseases of the blood and blood-forming organs andcertain disorders involving the immune mechanism4E00-E89 Endocrine, nutritional and metabolic diseases908101.1%5F01-F99 Mental, Behavioral and Neurodevelopmental disorders747101.3%6G00-G99 Diseases of the nervous system622132.1%7H00-H59 Diseases of the eye and adnexa2606512.0%8H60-H95 Diseases of the ear and mastoid process653182.8%9I00-I99 Diseases of the circulatory system1378141.0%10J00-J99 Diseases of the respiratory system341123.5%11K00-K95 Diseases of the digestive system799253.1%12L00-L99 Diseases of the skin and subcutaneous tissue871617.0%136487430.7%14M00-M99 Diseases of the musculoskeletal system and connectivetissueN00-N99 Diseases of the genitourinary system672101.5%15O00-O9A Pregnancy, childbirth and the puerperium2267452.0%16P00-P96 Certain conditions originating in the perinatal period443122.7%17Q00-Q99 Congenital malformations, deformations and chromosomalabnormalitiesR00-R99 Symptoms, signs and abnormal clinical and laboratoryfindings, not elsewhere classifiedS00-T88 Injury, poisoning and certain other consequences ofexternal causesV00-Y99 External causes of 266372.9%721849431.3%18192021TotalZ00-Z99 Factors influencing health status and contact with healthservices7
Recoding in ICD-11 Each ICD-10-CM code was recoded in ICD-11 by 2terminologists (Julia – NLM, Shannon – NCHS)independently, results compared and discussed untilconsensus is reached. Coding guidelines Use online WHO ICD-11 browser Follow ICD-11 coding reference guide for morbidity Ignore parts of the names that convey absence of informatione.g., gout unspecified, Zoster without complications Use ICD-11 codes that are equivalent to or broader than ICD-10CM code If no equivalent code is found, try postcoordination as directedby ICD-11 browsera U.S. National Library of Medicine8
Postcoordination in ICD-11 New feature Allows combination of codes (“code clustering”) torepresent new meaning ICD-11 allows two kinds of post-coordination: Two or more main (“stem”) codes (connected by “/”)Urinary tract infection due to Extended spectrum beta-lactamase producingEscherichia coli GC08.0 / MG50.27 GC08.0 Urinary tract infection, site not specified, due to Escherichia coli MG50.27 Extended-spectrum beta-lactamase producing Escherichia coli Main (“stem”) codes with one or more extension codes (connected by “&”)Tuberculosis of prostate 1B12.5 & XA63E5 1B12.5 Tuberculosis of the genitourinary system XA63E5 Prostate glanda U.S. National Library of Medicine9
ICD-11 for Morta I 1ty an d Morb"d"1 1ty Sta t"15t"1cs (Versio n. 09/2020)Search ? [ Advanced16 Diseases of t he genitourinary system" ENSearch JFoundation URI: http://id.who.int/icd/entity/905570639Diseases of t he fema le genital syst em Diseases of t he ma le genital system Disorders of breastDiseases of t he urinary system Glomeru lar diseases Renal tubulo-interstitial diseases Kidney fa ilure Urolit hiasis Cyst ic or dysplast ic ki dney disease GB90 Certai n specified disord ers of ki dney orureter Certain speci fied diseases of urinary system GCOO Cysti tisGCOS.O Urinary tract infection, site not specified, due to Escherichia coliParentGC08 Urinary tract infection, site not specifi edShow all ancestors 00PostcoordinationOGC08.0 Urinary tract infection, site not specified, due to Escherichi a coliL Associated withMGS0.27 Extended spectrum beta-lactamase producing Escherichia coliCode: GC08.0/ MG50.270Add detail to Urinary tract infection, site not specified, due to Escherichia coli GCOl Ot her disorders of bladder GC02 Uret hrit is and urethral syndromeHas manifestation (use additional code, if desired .) GC03 Uret hra l stricture1G40Sepsis wit hout sept ic shock GC04 Fist ula of t he genitourinary t ract1G41Sepsis wit h septic shockGCOS Prolapsed urethral mucosaGC06 Uret hra l diverticulumGC07 Urethra l caru ncleJB40.0Puerperal sepsisKA 60Sepsis of fetus or newbornAssociated with (use additional code, if desired .)MGS0.2GC08.0 Urina ry t ract infection, site nots ecifi ed, due to Escherichia coliGC08.1 Uri nary t ract infection, site notspecified, due to Klebsiella pneumoniaeMGS0.20Antibiotic resistant Escherichia coliSulfonamide or t rim ethoprim resistant Escherichia coliMGS0.21Fluoroquinolone resistant Escherichia co liMGS0.22Third generation cephalosporin resistant Escheri chia co liMGS0.23Fourth-g eneration cepha lospori ns resistant Escheri ch ia coliGC08.2 Urinary t ract infection, site notMGS0.24Carbapenem resist ant Escheri chia colispecified, due to ProteusMGS0.25Polymyxin resistant Escherichia co liJB40.3 Urinary tract infection followingMGS0.26Penicillin resistant Escherichia colideliveryMGS0.27Extended s ectrum beta- lactamase roducin Escheri chia colia U.S. National Library of Medicine10
Three levels of representationExampleFull representation without Q02 Microcephaly postcoordinationLA05.0 MicrocephalyNumber of ICD-10CM codes (%)222 (23.5%)Full representation withpostcoordinationH52.13 Myopia, bilateral 9D00.0 Myopia & XK9JBilateral81 (8.6%)Partial representationS80.211A Abrasion, rightknee, initial encounter NC90.0 Abrasion of knee &XK9K Right640 (67.9%)Total943 (100%)11
rageFull representation withoutpostcoordination% of 0.0%27.0%47.1%% of 0.0%21.5%53.1%Full representation withpostcoordination% of .7%% of Partial representation% of 5.0%59.5%42.2%% of %62.0%38.6%12
Inter-rater agreement in ICD-11 coding943 (100%)ICD-10-CMcodes227 (24.1%)disagreed on mainICD-11 code716 (75.9%)agreed on mainICD-11 code380 (40.3%)neither usedPCPC:postcoordination83 (8.8%)one usedPC253 (26.8%)both used PC199 (21.1%)same PCcodes(78.7%agreement)111 (11.8%)neither usedPC54 (5.7%)different PCcodes69 (7.3%)one usedPC47 (5%)both usedPC
Failure analysis Reviewed all codes that were partially represented Reasons for not achieving full representation:1. Missing information in postcoordination Postcoordination not allowed e.g.,–H93.13 Tinnitus, bilateral MC41Tinnitus (does not allowpostcoordination) Addition of existing extension code not allowed e.g.,–M25.552 Pain in left hip ME82 Pain in joint & XA4XS4 Hip joint(further addition of extension code XK8G Left is not allowed) Missing extension code e.g.,a –S00.31XA Abrasion of nose, initial encounter–O16.3 Unspecified maternal hypertension, third trimester–T45.515A Adverse effect of anticoagulants, initial encounter»ICD-10-CM distinguishes between adverse effect (drug properlyadministered), poisoning (improper use) and underdosing (takingless than required)U.S. National Library of Medicine14
Reasons for not achieving full representation (cont’d):2. Residual categories Both ICD-10-CM and ICD-11 have “catch-all” residualcategories (e.g., R18.8 Other ascites, R26.2 Difficulty inwalking, not elsewhere classified) to ensure coding ofevery possible case The meaning of these categories depends on theneighboring codes (mainly the siblings) Even apparently equivalent codes can have differentmeanings e.g. H26.8 Other specified cataract 9B10.2YOther specified cataracts15
Reasons for not achieving full representation (cont’d):3. ICD-11 more specific than ICD-10-CM Usually we choose an ICD-11 code that is equivalent orbroader than the ICD-10-CM code In some cases, ICD-11 coding guidance points to aspecific code e.g. a ICD-10-CM code M62.82 RhabdomyolysisICD-11 index term “rhabdomyolysis” points to FB32.20 Idiopathicrhabdomyolysis, which is more specific than rhabdomyolysisPostcoordination is not applicable in these cases becauseit can only refine a code and make it more specific, but notmore generalU.S. National Library of Medicine16
Reason for failure of full representation1. Missing information inpostcoordinationEpisode of care3. ICD-11 more specific375 (39.8%)Laterality53 (5.6%)Mode of exposure35 (3.7%)Trimester of pregnancy16 (1.7%)Other missing information- anatomy- devices- injury dimension- etiology- substances- severity- temporality- external cause- histopathology- capacity context- OthersTotal2. Residual categoriesICD-10-CM codes (%)45 (4.8%)25 (2.7%)25 (2.7%)16 (1.7%)11 (1.2%)10 (1.1%)5 (0.5%)4 (0.4%)3 (0.3%)1 (0.1%)100 (10.6%)245 (26.0%)131 (13.9%)13 (1.4%)17
ICD-11 enhancements Some minor changes in ICD-11 can make a big difference Add 9 extension codes (3 episode of care, 3 trimester of pregnancy, 3mode of drug exposure) Allow adding laterality modifier to anatomic entitiesNumber of ICD-10-CM codes (%)Existing ICD-11Full representation withoutpostcoordinationEnhanced ICD-11222 (23.5%)222 (23.5%)81 (8.6%)332 (35.2%)Partial representation640 (67.9%)389 (41.3%)Total943 (100%)943 (100%)Full representation withpostcoordination18
Coding guidance review ICD-10-CM and ICD-11 have inclusions, exclusions andan index that provide guidance to coders and delineatethe boundaries of a code ICD-11 has a description (definition) for most codes The coding guidance is important in understanding thefull meaning of a code and what it encompasses.Apparently equivalent codes can have differentmeanings due to differences in the coding guidance We reviewed the coding guidance of the ICD-10-CMcode and its corresponding ICD-11 target for conflicta U.S. National Library of Medicine19
Definitions The definition of each ICD-11 code was reviewed withthe inclusions and exclusions of the ICD-10-CM codeand its ancestors No conflict detecteda U.S. National Library of Medicine20
Inclusions and exclusions1. Inclusions of the ICD-10-CM code and its ancestorswere reviewed for conflicts with exclusions of the ICD11 code and its ancestorsA41.9 Sepsis,unspecifiedorganismInclusions:Septicemia NOS1G40 Sepsiswithout logicalfindings in blood,blood-formingorgans, or theimmune system21
Inclusions and exclusions (cont’d)2. Exclusions of the ICD-10-CM code and its ancestorswere reviewed for conflicts with inclusions of the ICD11 code and its Fecal l impactionK56.41 Fecalimpaction22
Indexes An index conflict In the ICD-10-CM index, an index term points to the ICD-10-CMcode The same index term occurs in the ICD-11 index, but points toan ICD-11 code other than the chosen target code Because of the large number of index terms, we werenot able to do a comprehensive review Focused review Index terms were normalized by the UMLS lexical tool (luinorm)to remove differences due to punctuation, capitalization,inflexion, word order etc. Same index entries in ICD-10-CM and ICD-11 were found bymatching the normalized index terms Cases in which an index term in ICD-11 pointed to a codedifferent from the chosen target code were revieweda U.S. National Library of Medicine23
Index conflictLA8B.4 Patentarterial ductQ25.0 Patentductus arteriosusICD-10-CM indexICD-11 indexAneurysm- patent ductus arteriosus Q25.0LA8B.Y Otherspecifiedcongenitalanomaly of greatarteries includingarterial duct24
Coding guidance conflicts - actual Actual conflicts – need to change target ICD-11 codeB19.20Unspecified viralhepatitis Cwithout hepaticcomaICD-10-CM index1E5Z Viralhepatitis,unspecifiedICD-11 indexHepatitis- C (viral) B19.201E51.1 Chronichepatitis C25
Coding guidance conflicts - potential Target ICD-11 code is correct in general, but incorrect inspecific cases. Three types:1. Partial overlap – a specific case points to a broad codeA41.9 Sepsis,unspecifiedorganismInclusions:Septicemia NOS1G40 Sepsiswithout logicalfindings in blood,blood-formingorgans, or theimmune system26
Coding guidance conflicts - potential2. Granularity difference – a specific case points to a ns:Fecal l impactionK56.41 Fecalimpaction27
Coding guidance conflicts - potential3. Different default assumptionO03.9 Completeor unspecifiedspontaneousabortion withoutcomplicationICD-10-CM indexJA00.09Spontaneousabortion,complete orunspecified,withoutcomplicationICD-11 indexAbortion (complete) (spontaneous)O03.9JA00.29 Unspecifiedabortion, complete orunspecified, withoutcomplication28
Coding guidance conflicts resultsInclusions and exclusionsNo. of conflictsActual conflictIndexICD-10-CM codesNo. of conflictsICD-10-CM fferent defaultassumption112012101026693Potential conflict--partial overlapTotal29
Summary of findings Based on 943 frequently used ICD-10-CM codes,representing 60% of usage from each chapter, ICD-11can achieve 23.5% full representation without postcoordination 8.6% full representation with postcoordination (can be increasedto 35.2% with minor enhancements) 67.9% partial representation Review of inclusions, exclusions and indexes revealedconflicts in about 10%, mostly potential conflicts that donot require change of target ICD-11 codesa U.S. National Library of Medicine30
Can ICD-11 replace ICD-10-CM? Based on the General Equivalence Maps (published byCMS), only 24.3% of ICD-9-CM codes have exactmatches in ICD-10-CM Transition from ICD-10-CM to ICD-11 may not be moredisruptive than transition from ICD-9-CM to ICD-10-CM The disruption can be even less with postcoordination Caveats: Postcoordination has never been used in ICD coding Impact on tooling and coder education May increase coding variability – in our study, coder variability inpostcoordination is about the same as for the main codesa U.S. National Library of Medicine31
Advantages of using ICD-11 for morbidity Avoid the cost of creating and maintaining ICD-11-CM Earlier use of an up-to-date, international medicalclassification Avoid divergence of the US Clinical Modification from theinternational core Theoretically, ICD-10-CM should be totally compatible with ICD-10 However, significant differences can be observed e.g. E14 Unspecified diabetes mellitus is not found in ICD-10-CM(diabetes unspecified is coded as type 2) K68 Disorders of retroperitoneum is not found in ICD-10 Other differences are likely to exist due to differences ininclusions, exclusions and indexing as shown in our study ICD-11 Foundation Component (logical underpinning) Alignment with other terminologies e.g. SNOMED CT Automated codinga U.S. National Library of Medicine32
New options for CM? Even if ICD-11 cannot totally replace ICD-10-CM, somealternatives to a full-fledged ICD-11-CM may be worthconsidering “ICD-11-CM lite” – adopt some chapters of ICD-11 as-is, onlymodify chapters that have more differences from ICD-10-CM “Extension of extension” – US will maintain its own additional set ofICD-11 extension codes to provide the necessary postcoordination “ICD-11-CM as a linearization” The various ICD-11 code sets for different use cases can bederived from the Foundation Component as linearizations If ICD-11-CM can use the same logical underpinning and begenerated as another linearization, it will be guaranteed to betightly aligned with ICD-11a U.S. National Library of Medicine33
Thank you!34
G00-G99 Diseases of the nervous system 622 : 13 : 2.1% : 7 H00-H59 Diseases of the eye and adnexa : 2606 : 51 : 2.0% : 8 ; H60-H95 Diseases of the ear and mastoid process 653 : 18 : 2.8% : 9 I00-I99 Diseases of the circulatory system : 1378 : 14 : 1.0% : 10 ; J00-J99 Diseases of the respiratory system 341 : 12 : 3.5% : 11 K00-K95 Diseases of .
ICD-9 724.02 ICD-10 M48.06 Spinal stenosis, lumbar region ICD-9 720.2 ICD-10 M46.1 Sacroiliitis, not elsewhere classified ICD-9 724.8 ICD-10 R29.898 Other symptoms and signs involving the ** musculoskeletal system ICD-9 721.42 ICD-10 M47.16 Other spondylosis with myelopathy, lumbar region ICD-9 723.1 ICD-10 M54.2 Cervicalgia ICD
More on ICD-10. ICD-10-PCS replaces ICD-9-CM inpatient procedure coding: ICD-9-CM procedure codes 3 to 4 numeric digits ICD-10-CM codes 7 alphanumeric digits ICD-10-PCS code format substantially different from ICD -9 Unlike ICD-9, ICD-10
ICD-10 Tips from PHCS The Road to ICD-10 Flyer AMA ICD-10 Project Plan Template Educational Tools Folder Precyse University ICD-10 Physician Office Solution Brochure Precyse Catalog of ICD-10 Courses ICD-10 Precyse Apps for Physicians Resources Folder Free Resources ICD-9 to ICD-10 Crosswalk of Most Common ICD-9 .
Dec 14, 2010 · ICD-9. ICD-10. ICD-9. ICD-10. Inactive. Active. Combined Code Set. Core Technologies. ICD-9 and ICD-10 code values are unique. Generally, the industry is taking one of two approaches as it relates to the ICD-10 transition: Remediation: Modify/expand all systems and processes to accommodate ICD-
ICD-10 to ICD-10-CM Based on FY2017 ICD-10-CM codes Category and subcategory codes are shaded in grey and marked with an Cells shaded in pink and marked with an *indicate the preferred code when a single code maps to multiple codes (see Introduction) Reportable Neoplasms . Type of Code ICD-10 Category Chapter II (Neoplasms) ICD-10 Term . ICD .
7/13/2015 1 Tonya Mitchell, RHIT July 17, 2015 Objectives Review the History of ICD‐10 Discuss the Myths and Facts of ICD‐10 Discuss GlGeneral DttiDocumentation CtConcepts Review ICD‐10 Documentation Concepts Analyze Documentation for Top Diagnosis in ICD‐10 WHY CHANGE FROM ICD‐9 TO ICD‐10? ICD‐9 was developed in the 1970s and cannot support current
of the previous ICD-9 coding system. The volume of ICD-10 codes as compared to ICD-9 codes is significant because in ICD-10, the code size has been expanded, code values and interpretations have been redefined and specificity has been further improved. Global ICD-10 adoption The current version of ICD is ICD-10, which was adopted by the World .
According to CMS, GEMs are “a tool to assist with the conversion of ICD-9-CM codes to ICD-10 and the conversion of ICD-10 codes back to ICD-9-CM. The GEMs are forward and backward mappings between the ICD-9-CM and ICD-10 coding systems.” Watch out: Although you’ll see the term “cr
