The ICD-9-CM codes have been available for use
since 1977. However, only since 1989 have the ICD-
9-CM codes been required for physician professional
services. In the spring of each year, diagnosis codes
are reviewed and new codes are created. At the same
time, other diagnosis codes are revised to reflect the
diseases and conditions physicians are treating. The
new, revised and deleted code changes are published
in the spring and are implemented for coding
on Oct. 1 of each year. ICD-9 and ICD-10 coding
guidelines are similar. The system has been changed
to allow more diagnosis codes for specific diseases,
to give more options for tracking morbidity and
mortality for the Center of Disease Control and to
have continuity with the World Health Organization.
There is more flexibility with ICD-10 since there are
more codes to choose as the appropriate diagnosis.
Since the coding guidelines are similar for ICD-9
CM, emphasis will be placed on learning the new ICD-10CM codes, which will become the standard
coding system for use in physician practices.
ICD-10-CM coding system is arranged in the same
format as the ICD-9CM book with the book divided
into two sections: the index − an alphabetical list
of terms and their corresponding code − and the
tabular section − a sequential alphanumeric list of
codes divided into chapters based on body system
or condition. The Alphabetical Index is arranged
with an index to Disease and Injuries, The Neoplasm
Table, Table of Drugs and Chemicals and the Index
to External Causes and injuries. The Tabular list
contains categories and subcategories of codes. The
format for the codes is alphanumerical, with each
code beginning with an alpha character and then
having a mix of alpha and numerical characters for
each code. A valid code may range from three to
seven characters.
These diagnosis codes are divided into chapters,
sections, subsections and subcategories. The list
below gives you a look at the code breakdown:
• First character of a three character category is a
letter
• Second and third characters may be numbers or
alpha characters
• Fourth and fifth characters define subcategories
and also may be either alpha or numerical
characters
• Sixth and seventh characters also may be either
numerical or alphabetical. These characters are
further divisions of the subcategories described
in the first through fifth position of the ICD-
10CM codes.
Unique to the ICD-10CM coding system is the use
of the letter “X” as a placeholder when the diagnostic
code needs to be expanded but there isn’t a number
or letter appropriate to use to complete the code
expansion for a specific place. For example, an initial
encounter for a scorpion sting would be coded as
T63.2X1. The “x” is required to enable the expansion
of the code to the seventh place to complete the code.
The Alphabetical Index section of the ICD-10CM
books is arranged in the same manner as the ICD-
9 CM book, with the exception that it lacks a
hypertension table. The alphabetical section also
has a guide to indicate with a √ when the code will
need an additional digit to make for a complete code.
The alphabetical section is considered the index
for the numerical section of the book and should
be used as a person would use any other index, as
a beginning point to determine where to find the
correct code. Behind the alphabetical section is the
Neoplasm Table. The Neoplasm Table list contains
diagnosis codes for malignant primary, malignant
secondary, Ca in situ, benign, uncertain behavior,
and unspecified behavior neoplasms. Some of these
codes may require additional digits not shown in the
Index. Again, to code completely, the codes will need
to be selected from the Tabular section of the ICD-
10CM book to verify laterality as well as specificity
for the code. The third index in the alphabetical
section is the Table of Drugs and Chemicals and
the last index is the Table of External Cause or
Accident Codes. Again, the appropriate manner for
coding would be to use these sections as indexes and
determine the appropriate code from the tabular
section of the book.
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