ICD-1O Informational Series, Part IV: Example of Coding Changes

January 31, 2014

As a result of feedback from MaineCare’s Provider Readiness survey participants, we have developed an ICD-10 Informational Series for providers in order to share information and to direct you towards preparing for transitioning from ICD-9 to ICD-10.

The informational series will include the following parts or topics:

  • Part I: Overview of Provider Survey Results

  • Part II: MaineCare’s Provider Outreach Plan

  • Part III: ICD-10 Provider Impact

  • Part IV: Example of Coding Changes

  • Part V: Provider Preparation/Helpful Hints

Provider Readiness Survey results indicated that providers would benefit from understanding how ICD-10 is different from ICD-9. As a result, MaineCare would like to share the information below, which describes some of the changes in ICD-10. For more detailed information, please see the resources listed at the bottom of this message.

How are ICD-10 codes different from ICD-9 codes?

Longer codes: ICD-9 codes are 3-5 characters, while ICD-10 codes can be up to 7 characters.

  • Providers need to make sure their systems, processes, and forms can accept the new, longer codes.

More granular: ICD-10 codes are far more granular than ICD-9 codes and provide much more specific information.

  • The greater specificity of ICD-10 means that one ICD-9 code can be represented by multiple ICD-10 codes.

  • Providers need to determine which ICD-10 codes to use in place of ICD-9 codes.

The following example shows how one ICD-9 code can be represented by multiple ICD-10 codes:

ICD-9 Code

996.71 Other complications due to heart valve prosthesis

ICD-10 Codes

  • T82.817A Embolism of cardiac prosthetic devices, implants and grafts, initial encounter

  • T82.827A Fibrosis of cardiac prosthetic devices, implants and grafts, initial encounter

  • T82.837A Hemorrhage of cardiac prosthetic devices, implants and grafts, initial encounter

  • T82.847A Pain from cardiac prosthetic devices, implants and grafts, initial encounter

Centers for Medicaid and Medicare Services (CMS) has provided a tool, called General Equivalence Mappings (GEMs) that can assist providers with determining which ICD-10 codes to use. You can access GEMS on the CMS website.

For more information, go to MaineCare’s ICD-10 webpage or CMS’s ICD-10 Provider Resources’ webpage. Please send questions about ICD-10 to MaineCare’s ICD-10 email box