ICD-10 after the code freeze: Finally, the ice is breaking

May 25, 2016 / By Rhonda Butler

In an earlier blog, I said it is a common misconception that ICD-10-CM/PCS is brand spanking new. But it isn’t. It is unused. Just as putting meat in the freezer does not make it fresh, a frozen code set just lets you put off using it for a while.

The industry wanted a code freeze for two years prior to implementation. That turned into four because of the two additional delays. This extended code freeze has consequences for the next several years, but for now I just want to focus on this year—the annual code update for October 1, 2016.

This year’s update contains the four-year backlog of proposals presented at the twice yearly C&M meeting and receiving public support during the comment period that follows each meeting. You may have heard the phrase Coordination & Maintenance, or the acronym C&M. It is a public forum for proposing changes to the ICD codes that dates from around the time of ICD-9 adoption, the UHDDS (Uniform Hospital Discharge Data Set) and the use of DRGs for Medicare payments. These were all instituted at roughly the same time more than 30 years.

The annual code update to ICD-10-CM/PCS is typically posted in June on the CMS and CDC websites.

Please do yourself a favor and don’t freak out over the number of new codes. What is meaningful to focus on are the new distinctions being added (aka new axes of classification), not how they all multiply out into individual codes. For example, there are new diabetic retinopathy codes in ICD-10-CM that specify the type of retinopathy and whether the diagnosis is for the left eye, right eye, or both eyes. There are more than 250 new codes when you multiply out all of the possibilities, but clinically it is a single area of change where two distinctions have been added—type of diabetic retinopathy and laterality.

As the code set gets updated, what we should pay attention to is the number of changes—in clinical terms for diagnosis codes, and in terms of new values added to the PCS tables for procedure codes—rather than focusing on the number of resulting codes. Otherwise, understanding the significance of the change is lost in the trivial pursuit of numbers.

Rhonda Butler is a clinical research manager with 3M Health Information Systems.