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Clinician's Primer to ICD-10-CM Coding for Cleft Lip/Palate Care
2015, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association
https://doi.org/10.1597/15-219
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Abstract
On or after October 1, 2015, the United States will require use of the Clinical Modification of the International Classification of Diseases, 10th Revision (ICD-10-CM) for diagnostic coding. This primer was written to assist the cleft care community with understanding and use of ICD-10-CM for diagnostic coding related to cleft lip and/or palate (CL/P).
Key takeaways
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- The U.S. requires ICD-10-CM for diagnostic coding effective October 1, 2015, replacing ICD-9-CM.
- ICD-10-CM contains 68,069 diagnostic codes, a significant increase from 14,025 in ICD-9-CM.
- The primer helps the cleft care community understand ICD-10-CM coding for cleft lip/palate (CL/P).
- ICD-10 codes are alphanumeric and up to seven characters long, enhancing coding specificity.
- Transitioning to ICD-10-CM presents challenges, necessitating training and system updates for clinicians and administrators.
References (13)
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FAQs
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What advances does ICD-10-CM offer over ICD-9-CM for cleft coding?
ICD-10-CM includes 68,069 diagnostic codes compared to ICD-9-CM's 14,025, allowing for enhanced specificity in cleft diagnoses. For example, the new system specifies different codes for bilateral and unilateral clefts, improving clinical documentation.
How does general equivalence mapping facilitate the ICD transition?
General equivalence maps (GEMs) guide the transition between ICD-9-CM and ICD-10-CM for coding purposes, allowing bidirectional conversion. However, many ICD-9 codes may only map approximately, complicating the transition for precise clinical coding.
In what ways has the structure of coding changed from ICD-9-CM to ICD-10-CM?
ICD-10-CM codes are alphanumeric and can be up to seven characters long, compared to ICD-9-CM's numeric codes which are five characters. This change provides a more detailed framework for specific conditions such as cleft lip and palate.
What challenges are anticipated during the ICD-10-CM transition period?
The transition will require substantial technological adjustments due to format differences; ICD-10-CM's alphanumeric nature necessitates system reprogramming. Mixed year data sets during the transition will further complicate record keeping and clinical coding accuracy.
How does coding differ from clinical classification in health care systems?
Coding provides a structured way to index clinical entities for management, while clinical classification helps structure clinical thinking regarding pathologies. Each serves distinct purposes: coding supports billing and statistical reporting, whereas classification informs clinical decision-making.