Diagnosis Codes

Diagnosis Codes Key Points

In Healthcare, the different diagnosis code sets are extremely important and can sometimes be tricky to deal with. But don't worry, when you are done with this section, you'll be a able to crack the code like a pro!

What is a diagnosis?

Let’s imagine that you see a doctor and you have some symptoms such as coughing and a stomach ache and then your doctor magically comes up with a diagnosis. As we will learn later this diagnosis is a key piece of information that connects so much of the encounter experience together.

ICD10

ICD10: International Classification of Diseases 10

• Also known as ICD10
• Standard developed by WHO: World Health Organization and in 10th revision

ICD10-CM

ICD10-CM: International Classification of Diseases 10 - Clinical Modification

Diagnosis code standard used in the U.S.

• Maintained by U.S. CDC
• Contains a wide variety of diseases and conditions
• Used for Medical claims, disease epidemic, and mortality tracking

ICD9 to 10

The U.S. had been using ICD9 since 1979 until it adopted ICD10 in October of 2014. The US lagged a bit behind the rest of the world who had adopted ICD10 much earlier. The reason for the changes from ICD9 to ICD10 is that the code set was not robust enough to meet future healthcare needs.

Important Changes:

• 14,025 codes => 69,823 codes
• Up to 7 characters
• Created a much higher level of detail
  • Included things like laterality or side of injury

You can learn more by looking at the CDC's Rationale

ICD10- CM Code Structure

[ XXX ].XXX X

The first part is the category of the diagnosis and it is the first three characters and could be an S code like the injury category. There are 21 different categories and these range from the disease of the respiratory system to injury, poisoning, and certain other consequences of external causes.

XXX.[ XXX ] X

The Second is the etiology, anatomic site, and manifestation part which can be up to 3 more characters and is essentially the cause for a condition or disease or the location of the condition.

XXX.XXX [ X ]

Finally, the third part is the extension which is the last character and can be tricky b/c it can often be null or has an X placeholder. It is often used with injury-related codes referring to the episode of care.

Additional Resources

Code Structure
Coding Guidelines

QUESTION:

Again we will go over this more in-depth in the next section, but see if you can use your intuition to figure out the correct code for normal first pregnancy in the third trimester?

Please use this website 2020 ICD-10CM Codes to help answer this question.