ICD-10 CODING – the facts

The new ICD-10 code system has many more codes to deal with. It currently contains 69,099 diagnostic codes compared with 14,315 codes in ICD-9, five times as many.

The expertise involved in using all of the additional codes will require far more documentation than the older version.

The labor intensity in the coding process will be far more complicated and will create a significant coder shortage.

Experienced coders will need training on adapting to the new codes and it is difficult to find skilled training programs or trainers. .

The ICD-9 codes will continue to be used so coders will need to know how to use both sets of codes. In fact they may use dual coding systems for some time as not all payers will convert (industrial insurers). Billing and coding with both ICD-10-CM and ICD-9-CM for workers compensation and auto claims do not fall under HIPAA mandates so may not feel the push to transition to ICD-10. For this reason proficiency in ICD-9-CM remains extremely important.

The new conventions using ICD-10 require a higher level of specificity than what is found in ICD-9, necessitating a strong foundation in anatomy and terminology. Our medical terminology training course has always provided the best foundation possible for any coding training, including complete and thorough knowledge of medical terminology, anatomy, physiology, pharmacy, and disease processes as well as surgical procedures and related terminology.


There are many similarities between ICD-9-CM and ICD-10-CM in the guidelines, which will help ease your transition. Some of the differences you will encounter will include:

  • Higher level of specificity. Codes go up to seven characters in length.
  • Expanded injury codes, which group codes by site of injury in ICD-10-CM instead of type of injury in ICD-9-CM.
  • Creation of diagnosis/symptom combination codes, which may actually allow for reporting of fewer codes in ICD-10-CM.
  • Alphanumeric structure using all digits and characters except the letter U. This allows for flexibility and has the space needed to add new codes as needed.
  • In ICD-10-CM you will be able to describe the location, e.g., if the condition affects the left side, right side or if it is bilateral.
  • Seventh character extensions: The seventh character extender must always be the seventh character. Examples of seventh character extenders are A for active treatment; D for subsequent treatment; and S for sequela.
  • “Dummy” place holders. Because of the need for the seventh digit character extender in certain situations, the code selection may only go up to character four or five meaning we will have to use the letter “x” to fill in up to the seventh character when needed.


Let’s take a look at this example:

Patient presents to the local emergency room for a laceration of the ulnar artery at the forearm on his right arm. This is the initial encounter. The code descriptors and numbers work as follows:

S55.011 Laceration of ulnar artery at forearm level, right

A-initial encounter

D-subsequent encounter


You know this is the initial encounter, so you would choose the extender “A” and code as S55.011A:

Extension “A,” initial encounter, is used while the patient is receiving active treatment for the injury.

In this example the S55.011 expresses the exact description so the data shows the laceration, what it is and where it is located. If the patient were seen in followup for that same injury, the “D” would be used. If the patient had an infected wound as a result of the injury, and was being treated for the infection itself, you would use the “S” designator extender.

As noted earlier, documentation will be a key solution in ICD-10-CM code selection success. If you have access to provider documentation or are working with a provider, showing him or her some of the changes now could help ease the transition with the performance of documentation audits. Look at existing documentation and make sure there is enough information documented in the record to assign the encounter with the seventh character extender, that laterality is well documented and that the provider is documenting with specificity on the site of the injury or details about the patient condition. Rest assured that once the transition is really implemented, you will be chasing for more information since providers typically need more than is typically available in a chart.

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