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The Department of Health and Human Services (DHHS) mandated that all HIPAA-covered entities transition to ICD-10 diagnosis (ICD-10-CM) and procedure (ICD-10-
PCS) codes for electronic health care transactions.
ICD-10-CM (Clinical Manifestation) is used in all health care settings.
ICD-10-PCS (Procedure Coding System) is used in hospital settings only.
On October 1st, 2015
http://www.theoma.org/node/5282. Accessed April 11, 2016.
ICD-10 Codes Are Not New to Disease Coding in the US
Since 1999, the US has used ICD-10 codes to classify causes of death reported on death certificates.
“Morbidity coders, who for almost 30 years have used a version of ICD-9, are buzzing about the [upcoming] transition to ICD-10-CM and ICD-10-PCS. But for mortality coders, using their version of ICD-10 is old hat.”
Dimick C. Mortality Coding Marks 10 Years of ICD-10. AHIMA Journal article. July 2, 2009. http://library.ahima.org/xpedio/groups/public/documents/
ahima/bok1_043992.hcsp?dDocName=bok1_043992. Accessed April 11, 2016.http://www.cdc.gov/nchs/hus/chartbook.htm. Accessed April 11, 2016. http://www.who.int/gho/child_health/mortality/mortality_under_five/en/index1.html . Accessed April 11, 2016.
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U.S. Researchers Can Benefit from the Rest of the World’s Experience with ICD-10
U. S
.
WHO publishes ICD-10
Death certificate coding now based on ICD-10
15+ years of mortality coding
with ICD-10
1990
1999
2016
U.S. Researchers Can Benefit from the Rest of the World’s Experience with ICD-10
U. S
.
WHO publishes ICD-10
Death certificate coding now based on ICD-10
15+ years of mortality coding
with ICD-10
1990
1999
2016
RE
ST
OF
WO
RL
D
2016
25+ Years of morbidity coding with
ICD-10 inEurope
Australia
Canada
South America
1990
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ICD-10-CM: Key Features and Enhancements
Increased specificity and clinical detail of ICD-10 coding includes:
Expanded Excludes Notes
More Logical Grouping of Codes
Laterality Identified
Combination Codes that Associate Etiology and Condition
1) Source: Renee Stantz, CPC, consultant with VEI Consulting Services. Modern Medicine Network/Medical Economics. ICD-10 documentation: The key to getting paid. Available at:
http://medicaleconomics.modernmedicine.com/managed-healthcare-executive/news/icd-10-documentation-key-getting-paid?page=full. Accessed April 11, 2016.
2) Endicott M. Coding Heart Procedures in ICD-9-CM and ICD-10-PCS. Journal of AHIMA. Feb 11, 2015. Available at: http://journal.ahima.org/2015/02/11/coding-heart-procedures-in-
icd-9-cm-and-icd-10-pcs/. Accessed April 11, 2016. 3)Prepared for Warner Robins, CME Event. http://www.slideshare.net/PYAPC/icd10-presentation-takes-coding-to-new-heights.
Accessed April 11, 2016.
“Any studies that use ICD codes for recording data over a period of time will need to incorporate some sort of mapping from ICD-9 to ICD-10…
Analytic Challenge:Longitudinal Studies that Span October 1, 2015
Vulcano D. ICD-10 Conversion and the Impact on Clinical Research. Journal of Clinical Research Best Practices, Vol. 11, No. 1, January 2015.
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“Any studies that use ICD codes for recording data over a period of time will need to incorporate some sort of mapping from ICD-9 to ICD-10…
01020304050
Disease PrevalenceJune 2015 - November 2015
Analytic Challenge:Longitudinal Studies that Span October 1, 2015
or it will seem that certain diseases are eradicated on October 1, 2015, just as new epidemics erupt on that date as well.”
Vulcano D. ICD-10 Conversion and the Impact on Clinical Research. Journal of Clinical Research Best Practices, Vol. 11, No. 1, January 2015.
GEMs: General Equivalence Mappings• Provides detailed bidirectional mappings.
• Allows identification of potential corresponding codes between ICD-9-CM/PCS and their counterparts in ICD-10-CM/PCS.
How Can I Perform Analyses that Integrate ICD-9-CM/PCS and ICD-10-CM/PCS Codes?
Mapping Between ICD-9 and ICD-10 Codes
(crosswalk) Executive Insight. Differentiating Winners and Losers; Staying on the ICD-10 ball to improve results. Posted on: August 14, 2014. http://healthcare-executive-
insight.advanceweb.com/Features/Articles/Differentiating-Winners-and-Losers.aspx. Accessed April 11, 2016.
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Change in Prevalence Rates Over Time
Healthcare Analyses Impacted by Introducing ICD-10 Codes
Generated using UBC’s SÆfetyWorks® and CEWorks® products. http://www.ubc.com/library/database-analytics-automation
Drug Safety Evaluation
Healthcare Analyses Impacted by Introducing ICD-10 Codes
Generated using UBC’s SÆfetyWorks® and CEWorks® products. http://www.ubc.com/library/database-analytics-automation
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Comparison of Health Care Utilization
Pre- vs. Post-Drug Launch
Healthcare Analyses Impacted by Introducing ICD-10 Codes
Generated using UBC’s SÆfetyWorks® and CEWorks® products. http://www.ubc.com/library/database-analytics-automation
ICD-10 Around the World
Maneesh JunejaHealth Data Consultant
MJ Analytics Limited, UK
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Mid 1990s
• UK 1995 (ICD-10)
• Finland 1996(ICD-10 FI)
• Sweden 1997 (ICD-10 SE)
• France 1997 (CIM 10)
• Estonia 1997 (ICD-10)
• Poland 1997 (ICD-10)
• Korea 1995 (KCD)
Late 1990s
• Australia 1998 (ICD-10 AM)
• Belgium 1999 (ICD-10 BE)
Early 2000s
• Germany 2000 (ICD-10 GM)
• Canada 2001 (ICD-10 CA)
• China 2002
Mid 2000s
• Ireland 2005 (ICD-10 AM)
ICD-10 Outside of the USA – The Story So Far
ICD-10 Around the World – Why Do Countries Modify the WHO Version of ICD-10?
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How Accurate Will ICD-10-CM Be in the USA?
Januel JM, Luthi JC, Quan H, et al. Improved accuracy of co-morbidity coding over time after the introduction of ICD-10 administrative data.
BMC Health Serv Res. 2011;11(1):194.http://www.idakoos.ca/hoodie+womens/trust-im-clinical-coder,487536
How Accurate Will ICD-10-CM Be in the USA?
Januel JM, Luthi JC, Quan H, et al. Improved accuracy of co-morbidity coding over time after the introduction of ICD-10 administrative data.
BMC Health Serv Res. 2011;11(1):194.http://www.idakoos.ca/hoodie+womens/trust-im-clinical-coder,487536
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Category Definition Number of
codes
Proportion of
all codes
A.1 Caused by a drug 104 20.6%
A.2 Caused by a drug or other
substance
78 15.4%
B.1 Poisoning by drug 133 26.3%
B.2 Poisoning by harmful use
of a drug or other
substance
15 3.0%
C ADE very likely 30 5.9%
D ADE likely 83 16.4%
E ADE possible 62 12.3%
Total 505 100.0%
Within A Country: Number of Codes Increase over Time
Category Definition Number of
codes
Proportion of
all codes
A.1 Caused by a drug 104 20.6%
A.2 Caused by a drug or other
substance
78 15.4%
B.1 Poisoning by drug 133 26.3%
B.2 Poisoning by harmful use
of a drug or other
substance
15 3.0%
C ADE very likely 30 5.9%
D ADE likely 83 16.4%
E ADE possible 62 12.3%
Total 505 100.0%In 2003, total codes n=482
Within A Country: Number of Codes Increase over Time
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Dollarphotoclub.com (id 71974435)
How Accurate Is ICD Coding for Epilepsy?
Jetté N, Reid AY, Quan H, Hill MD, Wiebe S. How accurate is ICD coding for epilepsy?. Epilepsia. 2010;51(1):62-9.
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ICD-9-CM PPV (95% CI)98.9 (96.1-99.7)
ICD-10 PPV (95% CI)98.6 (95.1-99.6)
How Accurate Is ICD Coding for Epilepsy?
Jetté N, Reid AY, Quan H, Hill MD, Wiebe S. How accurate is ICD coding for epilepsy?. Epilepsia. 2010;51(1):62-9.
Disease ICD-10 (Original WHOversion)
ICD-10-GM (German modification)
ChildbirthMultiple Delivery
O84 Z37 (9 sub-codes)
Z37.2 Twins, both liveborn
Z37.3 Twins, one twinliveborn, the other stillborn
Between Countries: Same Thing. Different Code.
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Disease ICD-10 (Original WHOversion)
ICD-10-CM (USmodification)
ICD-10-AM (Australian modification)
ICD-10-CA (Canadian modification)
Cardiovascular disease (limited to atherosclerotic cardiovascular heart disease)
I25
I25.0
I25.1
I25
I25.1
I25.10
I25.11
I25.110
I25.111
I25.118
I25.119
I25
I25.0
I25.1
I25.10
I25.11
I25.12
I25.13
I25
I25.0
I25.1
I25.10
I25.11
I25.12
I25.13
I25.14
I25.19
Between Countries: Same Disease. Different Code.
What Does This Mean for You?
Challenges ahead - shutterstock.com (id 89664115).
Croly J. General Equivalence Mappings (GEMs): Understanding Shortfalls. ICD-10 Hub Blog. 2011;
http://www.icd10hub.com/blog/index.php/2011/08/general-equivalence-mappings-gems-understanding-shortfalls/.Accessed Mar 27, 2016.
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General Equivalency Mappings
Q. How can I translate between ICD-10 and ICD-9?
Croly J. General Equivalence Mappings (GEMs): Understanding Shortfalls. ICD-10 Hub Blog. 2011;
http://www.icd10hub.com/blog/index.php/2011/08/general-equivalence-mappings-gems-understanding-shortfalls/.Accessed Mar 27, 2016.
General Equivalency Mappings
GEMs will be maintained for at least 3 years beyond October 1st, 2015
Q. How can I translate between ICD-10 and ICD-9?
Croly J. General Equivalence Mappings (GEMs): Understanding Shortfalls. ICD-10 Hub Blog. 2011;
http://www.icd10hub.com/blog/index.php/2011/08/general-equivalence-mappings-gems-understanding-shortfalls/.Accessed Mar 27, 2016.
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Not intended for:
Coding medical records
Case-by-case crosswalking
ICD-9 codes
ICD-10 codes
GEMs
General Equivalency Mappings
Designed for translating large batches of data:
• Converting payment systems
• Calculating equivalent reimbursements across code sets
• Linking data in clinical studies spanning Oct 1, 2015
• Analyzing data collected before and after Oct 1, 2015
ICD-9 codes
ICD-10 codes
GEMs
General Equivalency Mappings
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ICD-9 diagnoses
ICD-10 diagnoses
Leveraging GEMs for Data Analytics
ICD-9 diagnoses 9/37 24%
ICD-10 diagnoses 10/37 27%
Leveraging GEMs for Data Analytics
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ICD-9 diagnoses 9/37 24%
ICD-10 diagnoses 10/37 27%
19/37 51%GEMs
Leveraging GEMs for Data Analytics
*1 to many includes 1 to 1 approximate
matches with multiple choices
GEMs Translations: Examples and Pitfalls
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GEMs Translations: Examples and Pitfalls
174.4 (ICD-9 diagnosis)
Malignant neoplasm
of upper-outer quadrant
of female breast
C50.419 (ICD-10 diagnosis)
Malignant neoplasm
of upper-outer quadrant
of unspecified female breast
Because ICD-9 lacks laterality,
GEMs translations from ICD-9 to ICD-10
often exclude ICD-10 laterality codes.
ICD-9 to ICD-10
1-to-1 match
Laterality Codes – Translation Direction Matters
GEMs Translations: Examples and Pitfalls
174.4 (ICD-9 diagnosis)
Malignant neoplasm
of upper-outer quadrant
of female breast
C50.419 (ICD-10 diagnosis)
Malignant neoplasm
of upper-outer quadrant
of unspecified female breast
C50.41* (ICD-10 sub-category)
Malignant neoplasm of upper-outer quadrant
C50.411 of right female breast
C50.412 of left female breast
C50.419 of unspecified female breast
Because ICD-9 lacks laterality,
GEMs translations from ICD-9 to ICD-10
often exclude ICD-10 laterality codes.
174.4 (ICD-9 diagnosis)
Malignant neoplasm
of upper-outer quadrant
of female breast
ICD-9 to ICD-10
1-to-1 match
ICD-10 to ICD-9
many-to-1 match
Laterality Codes – Translation Direction Matters
Translating from
ICD-10 to ICD-9
Preserves Laterality
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Higher Levels – Broader Outcome Definitions
GEMs Translations: Examples and Pitfalls
GEMs defines generally equivalent codes at the individual code level.
GEMs can be leveraged at higher levels by translating all of the individual
codes that fall under a specific ICD-9 or ICD-10 category or sub-category.
The collective set of codes together with their translations can be used to
define health outcomes in healthcare data spanning October 1, 2015.
Higher Levels – Broader Outcome Definitions
GEMs Translations: Examples and Pitfalls
C50.41* Malignant neoplasm of
the breast, upper-outer quadrant
( irrespective of laterality )
GEMs diagnosis (narrow)
All C50.41x code translations
3 ICD-10 codes.
1 equivalent ICD-9 code.
ICD-10 to ICD-9
(sub-category level)
GEMs defines generally equivalent codes at the individual code level.
GEMs can be leveraged at higher levels by translating all of the individual
codes that fall under a specific ICD-9 or ICD-10 category or sub-category.
The collective set of codes together with their translations can be used to
define health outcomes in healthcare data spanning October 1, 2015.
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C50.* Malignant neoplasm of
the breast, anywhere
( irrespective of gender, laterality,and anatomical specificity–wherethe tumor manifested in the breast )
GEMs diagnosis (broad)
All C50.xxx code translations
53 ICD-10 codes.
9 equivalent ICD-9 codes.
Higher Levels – Broader Outcome Definitions
GEMs Translations: Examples and Pitfalls
C50.41* Malignant neoplasm of
the breast, upper-outer quadrant
( irrespective of laterality )
GEMs diagnosis (narrow)
All C50.41x code translations
3 ICD-10 codes.
1 equivalent ICD-9 code.
ICD-10 to ICD-9
(sub-category level)
ICD-10 to ICD-9
(category level)
GEMs defines generally equivalent codes at the individual code level.
GEMs can be leveraged at higher levels by translating all of the individual
codes that fall under a specific ICD-9 or ICD-10 category or sub-category.
The collective set of codes together with their translations can be used to
define health outcomes in healthcare data spanning October 1st, 2015.
Combination Codes – Nonreciprocal Translations
GEMs Translations: Examples and Pitfalls
250.70 (ICD-9 diagnosis)
Type 2 diabetes mellitus
with circulatory disorders
443.81 Peripheral angiopathy
785.4 Gangrene
E11.52 (ICD-10 diagnosis)
Type 2 diabetes mellitus
with diabetic peripheral angiopathy
with gangrene
ICD-10 combination codes for co-occurring
conditions often yield non-reciprocal GEMs
translations to secondary ICD-9 diagnoses.
ICD-10 to ICD-9
1-to-many match
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Combination Codes – Nonreciprocal Translations
GEMs Translations: Examples and Pitfalls
250.70 (ICD-9 diagnosis)
Type 2 diabetes mellitus
with circulatory disorders
443.81 Peripheral angiopathy
785.4 Gangrene
E11.52 (ICD-10 diagnosis)
Type 2 diabetes mellitus
with diabetic peripheral angiopathy
with gangrene
E11.51 (ICD-10 diagnosis)
Type 2 diabetes mellitus
with diabetic peripheral angiopathy
without gangrene
ICD-10 combination codes for co-occurring
conditions often yield non-reciprocal GEMs
translations to secondary ICD-9 diagnoses.
250.70 (ICD-9 diagnosis)
Type 2 diabetes mellitus
with circulatory disorders
ICD-9 to ICD-10
1-to-1 match
ICD-10 to ICD-9
1-to-many match
443.81 maps to ICD-10 code I79.8
“other disorders of arteries…”
785.4 maps to ICD-10 code I96
“Gangrene, not elsewhere classified”
GEMs Translations: Examples and Pitfalls
362.07 (ICD-9 diagnosis)
Diabetic macular edema
E11.311 (ICD-10 diagnosis)
Type 2 diabetes mellitus
with unspecified diabetic retinopathy
with macular edema
GEMs translations from ICD-9 to ICD-10
sometimes ignore specificity in order to provide
an exclusive 1-to-1 approximate match.
ICD-9 to ICD-10exclusive 1-to-1
approximate match
1-to-1 Approximate Matches & Specificity
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GEMs Translations: Examples and Pitfalls
362.07 (ICD-9 diagnosis)
Diabetic macular edema
E11.311 (ICD-10 diagnosis)
Type 2 diabetes mellitus
with unspecified diabetic retinopathy
with macular edema
Diabetes mellitus (with macular edema)
E08.3x1 due to underlying condition
E09.3x1 drug or chemical induced
E10.3x1 Type 1
E11.3x1 Type 2 E13.3x1 Other
GEMs translations from ICD-9 to ICD-10
sometimes ignore specificity in order to provide
an exclusive 1-to-1 approximate match.
362.07 (ICD-9 diagnosis)
Diabetic macular edema
(in combination with otherICD-9 diagnosis codes )
ICD-9 to ICD-10exclusive 1-to-1
approximate match
ICD-10 to ICD-9multiple many-to-1
combination matches
1-to-1 Approximate Matches & Specificity
Look for clues…
Explore GEMs translations
in both directions
E08.3 – Diabetes mellitus due to underlying conditionE08.311 – with unspecified diabetic retinopathy with macular edemaE08.321 – with mild non-proliferative diabetic retinopathy with macular edemaE08.331 – with moderate non-proliferative diabetic retinopathy with macular edemaE08.341 – with severe non-proliferative diabetic retinopathy with macular edemaE08.351 – with proliferative diabetic retinopathy with macular edema
E09.3 – Drug or chemical induced diabetes E09.311 – with unspecified diabetic retinopathy with macular edemaE09.321 – with mild non-proliferative diabetic retinopathy with macular edemaE09.331 – with moderate non-proliferative diabetic retinopathy with macular edemaE09.341 – with severe non-proliferative diabetic retinopathy with macular edemaE09.351 – with proliferative diabetic retinopathy with macular edema
E10.3 – Type 1 diabetes mellitus E10.311 – with unspecified diabetic retinopathy with macular edemaE10.321 – with mild non-proliferative diabetic retinopathy with macular edemaE10.331 – with moderate non-proliferative diabetic retinopathy with macular edemaE10.341 – with severe non-proliferative diabetic retinopathy with macular edemaE10.351 – with proliferative diabetic retinopathy with macular edema
E11.3 – Type 2 diabetes mellitus E11.311 – with unspecified diabetic retinopathy with macular edemaE11.321 – with mild non-proliferative diabetic retinopathy with macular edemaE11.331 – with moderate non-proliferative diabetic retinopathy with macular edemaE11.341 – with severe non-proliferative diabetic retinopathy with macular edemaE11.351 – with proliferative diabetic retinopathy with macular edema
E13.3 – Other specified diabetes mellitus E13.311 – with unspecified diabetic retinopathy with macular edemaE13.321 – with mild non-proliferative diabetic retinopathy with macular edemaE13.331 – with moderate non-proliferative diabetic retinopathy with macular edemaE13.341 – with severe non-proliferative diabetic retinopathy with macular edemaE13.351 – with proliferative diabetic retinopathy with macular edema
GEMs Translations: Examples and Pitfalls
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E08.3 – Diabetes mellitus due to underlying conditionE08.311 – with unspecified diabetic retinopathy with macular edemaE08.321 – with mild non-proliferative diabetic retinopathy with macular edemaE08.331 – with moderate non-proliferative diabetic retinopathy with macular edemaE08.341 – with severe non-proliferative diabetic retinopathy with macular edemaE08.351 – with proliferative diabetic retinopathy with macular edema
E09.3 – Drug or chemical induced diabetes E09.311 – with unspecified diabetic retinopathy with macular edemaE09.321 – with mild non-proliferative diabetic retinopathy with macular edemaE09.331 – with moderate non-proliferative diabetic retinopathy with macular edemaE09.341 – with severe non-proliferative diabetic retinopathy with macular edemaE09.351 – with proliferative diabetic retinopathy with macular edema
E10.3 – Type 1 diabetes mellitus E10.311 – with unspecified diabetic retinopathy with macular edemaE10.321 – with mild non-proliferative diabetic retinopathy with macular edemaE10.331 – with moderate non-proliferative diabetic retinopathy with macular edemaE10.341 – with severe non-proliferative diabetic retinopathy with macular edemaE10.351 – with proliferative diabetic retinopathy with macular edema
E11.3 – Type 2 diabetes mellitus E11.311 – with unspecified diabetic retinopathy with macular edemaE11.321 – with mild non-proliferative diabetic retinopathy with macular edemaE11.331 – with moderate non-proliferative diabetic retinopathy with macular edemaE11.341 – with severe non-proliferative diabetic retinopathy with macular edemaE11.351 – with proliferative diabetic retinopathy with macular edema
E13.3 – Other specified diabetes mellitus E13.311 – with unspecified diabetic retinopathy with macular edemaE13.321 – with mild non-proliferative diabetic retinopathy with macular edemaE13.331 – with moderate non-proliferative diabetic retinopathy with macular edemaE13.341 – with severe non-proliferative diabetic retinopathy with macular edemaE13.351 – with proliferative diabetic retinopathy with macular edema
GEMs Translations: Examples & Pitfalls
United Healthcare ICD-10 Code Lookup Tool. Available at: https://icd10codelookup.smartbaselink.com/ICDwidget.htm. Accessed March 27, 2016.
UMLSUnified Medical Language SystemMedDRA
Medical Dictionary for Regulatory Activities
ICD-9 ICD-10
ICD-9, ICD-10, UMLS and MedDRA
• ICD to MedDRA alignment is essential for using clinical data for drug safety monitoring.
• UMLS provides both ICD-9 and ICD-10 mappings to MedDRA preferred terms.
• ICD to MedDRA mappings are reliable for simple GEMs relationships where ICD-9 and ICD-10 terms
map to the same MedDRA preferred terms.
• ICD-10 to MedDRA mappings are less comprehensive than ICD-9 to MedDRA mappings,
and organizational differences between ICD-9 and ICD-10 can cause some generally equivalent
codes to map to different MedDRA terms.
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GEMs:• The U.S. standard for translating between ICD-9 and ICD-10
• Can be leveraged for grouping ICD-9 and ICD-10 diagnoses
at the category, sub-category and code level
Watch out for:
• Nonreciprocal translations
• Dropped laterality and specificity
when translating from ICD-9 to ICD-10
• ICD-9 secondary diagnoses when translating from
ICD-10 combination codes for co-occurring conditions
• Exclusive 1-to-1 approximate matches where a multiple-choice
1-to-1 approximate match would be more appropriate.
GEMs Translations: Examples and Pitfalls
Practical Considerations Regarding the ICD-10 Transition for
Researchers Using Observational Data
Rebecca Levin, MPHSenior Research Consultant, UBC
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Many Guidelines Are Available that Explain ICD-10 Coding
Rules for Health Care Providers and Administrators, BUT….
Pharmaceutical companies and regulatory agencies actively monitor product safety in the post-marketing environment using observational databases. FDA
http://www.ohdsi.org/. Accessed April 11, 2016.
www.fda.gov/downloads/Safety/.../UCM233360.pdf. Accessed April 11, 2016.
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Active Monitoring of Drug Safety
Pharmaceutical companies and regulatory agencies actively monitor product safety in the post-marketing environment using observational databases.
We always have to keep in mind, however, that the effectiveness of active surveillance with electronic data depends on the accuracy, specificity, and completeness of:
Drug Exposure DataDiagnosis (Outcome) Data
FDA
http://www.ohdsi.org/. Accessed April 11, 2016.
www.fda.gov/downloads/Safety/.../UCM233360.pdf. Accessed April 11, 2016.
“…..electronic medical record healthcare databases in the U.S. will now become a much richer data source to perform active drug safety surveillance.”
Enhanced Drug Safety Surveillance with ICD-10
Hohl CM, et al. J Am Med Inform Assoc 2014;21:547–557. doi:10.1136/amiajnl-2013-002116
http://googglet.com/images/funny%20icd%209%20codes. Accessed April 11, 2016.
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ICD-10-CM: Diagnosis Codes
Chapter XIXInjury, poisoning, and certain other consequences of external causes (letters S and T)
ICD-10-CM: Diagnosis Codes
Chapter XIXInjury, poisoning, and certain other consequences of external causes (letters S and T)
External causes of morbidity and mortality(letters V, W, X, and Y)
Chapter XX
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Fourth character specifies a drug exposureT36 Poisoning by Systemic Antibiotics
T36.0 Penicillins
T36.1 Cefalosporins and other beta-lactam antibiotics
T36.2 Chloramphenicol group
T36.3 Macrolides
T36.4 Tetracyclines
T36.5 Aminoglycosides
T36.6 Rifamycins
T36.7 Antifungal antibiotics, systemically used
T36.8 Other systemic antibiotics
T36.9 Systemic antibiotic, unspecified
Chapter XIX: T36-T40: Poisoning by Drugs, Medicaments
and Biological Substances
Y45 Analgesics, antipyretics and anti-inflammatory drugs
Y45.0 Opioids and related analgesics
Y45.1 Salicylates
Y45.2 Propionic acid derivatives
Y45.3 Other nonsteroidal anti-inflammatory drugs [NSAID]
Y45.4 Anti-rheumatics
Y45.5 Aminophenol derivatives
Y45.8 Other analgesics and antipyretics
Y45.9 Analgesic, antipyretic and anti-inflammatory drug, unspecified
Y52 Agents primarily affecting the cardiovascular system
Y52.0 Cardiac-stimulant glycosides and drugs of similar action
Y52.1 Calcium-channel blockers
Y52.2 Other anti-dysrhythmic drugs, not elsewhere classified
Y52.3 Coronary vasodilators, not elsewhere classified
Y52.4 Angiotensin-converting-enzyme inhibitors
Y52.5 Other antihypertensive drugs, not elsewhere classified
Y52.6 Anti-hyperlipidaemic and anti-arteriosclerotic drugs
Y52.7 Peripheral vasodilators
Y52.8 Anti-varicose drugs, including sclerosing agents
Y52.9 Other and unspecified agents primarily affecting the cardiovascular system
Chapter XX: External Causes of Morbidity and Mortality
Y40-Y59 – Drugs, medicaments, and biological substances
causing adverse effects in therapeutic use
Y46 Anti-epileptics and anti-parkinsonism drugs
Y46.0 Succinimides
Y46.1 Oxazolidinediones
Y46.2 Hydantoin derivatives
Y46.3 Deoxybarbiturates
Y46.4 Iminostilbenes
Y46.5 Valproic acid
Y46.6 Other and unspecified anti-epileptics
Y46.7 Anti-parkinsonism drugs
Y46.8 Anti-spasticity drugs
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No universally accepted ICD-10 coding algorithms exist to ensure consistent identification of adverse events in administrative data.
Canadian Study, 2014, first to evaluate literature:
Objective: Create a comprehensive set of ICD-10 codes used by health researchers to identify adverse drug events.
Results: 827 individual ICD-10 codes used in the health literature to identify adverse drug events:
Majority (78.8%) were disease manifestation codes.
Only 11.2% were external injury cause codes (ICD-10 Chapter XX).
Conclusions: Substantial variability exists in the methods used to identify adverse drug events in administrative data.
Most Common ICD-10 Codes
to Identify Adverse Events
Hohl CM, et al. J Am Med Inform Assoc 2014;21:547–557. doi:10.1136/amiajnl-2013-002116
ICD-10 Code Description
T88.6 Anaphylactic shock due to the adverse effect of a drug
T88.7 Unspecified adverse effect of a drug
N14.1 Nephropathy induced by drugs, medicaments and biological substances
K71.6 Toxic liver disease with hepatitis, not elsewhere classified
K71.9 Toxic liver disease, unspecified
L56.1 Drug photoallergic response
N14.2 Nephropathy induced by unspecified drug, medicament or biological substance
T88.3 Malignant hyperthermia due to anesthesia
Top 15 Disease Manifestation Codes Used to Identify Adverse Events
Hohl CM, et al. J Am Med Inform Assoc 2014;21:547–557. doi:10.1136/amiajnl-2013-002116
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The switch from ICD-9-CM to ICD-10-PCS has a profound effect on the codingof the procedure of injections and infusions in the inpatient setting.
Monitoring Product Safety With Observational Healthcare Data“The switch from ICD-9-CM to ICD-10-PCS has a profound effect on the
coding of the procedure of injections and infusions in the inpatient setting.”
Section=3Administration
Administrativ
e
2
Body
System
3Root
Operation
4Body
System
5 Approach
6 Substance
7Qualifier
Administration Section
Section 3 of ICD-10-PCS and includes infusions, injections.
These codes define procedures where a diagnostic or therapeutic substance
is given to the patient.
ICD-10-PCS: Procedure Codes
Anthelio Healthcare Solutions. Injections and Infusions. http://www.antheliohealth.com/downloads/23_Injections%20and%20Infusions_02112016.pdf. February 11,
2015. Vol 23. Accessed April 11,2016
The switch from ICD-9-CM to ICD-10-PCS has a profound effect on the codingof the procedure of injections and infusions in the inpatient setting.
Monitoring Product Safety With Observational Healthcare Data“The switch from ICD-9-CM to ICD-10-PCS has a profound effect on the
coding of the procedure of injections and infusions in the inpatient setting.”
2
Body
System
3Root
Operation
4Body
System
5 Approach
6 Substance
7Qualifier
Substance (character 6)
ICD-10-PCS: Procedure Codes
Anthelio Healthcare Solutions. Injections and Infusions. http://www.antheliohealth.com/downloads/23_Injections%20and%20Infusions_02112016.pdf. February 11,
2015. Vol 23. Accessed April 11,2016
Section=3Administration
Administrativ
e
4/14/2016
57
Section 3 Administration
Body System E Physiological System
Operation O Introduction: Putting in or on a therapeutic, diagnostic, nutritional,
physiological, or prophylactic substance except blood or blood products.
Body
System/Region
Approach Substance Qualifier
Epidural space Percutaneous 3 Anti-inflammatory
6 Nutritional Substance
7 Electrolytic and water balance substance
B Local Anesthetic
C Regional Anesthetic
H Radioactive Substance
K Other Diagnostic Substance
N Analgesics, Hypnotics, Sedatives
T Destructive Agent
Z no qualifier
ICD-10-PCS: Procedure Codes
3E0S33Z – Epidural injection of steroid for pain control
Section 3 Administration
Body System E Physiological System
Operation O Introduction: Putting in or on a therapeutic, diagnostic, nutritional,
physiological, or prophylactic substance except blood or blood products.
Body
System/Region
Approach Substance Qualifier
Epidural space Percutaneous 3 Anti-inflammatory
6 Nutritional Substance
7 Electrolytic and water balance substance
B Local Anesthetic
C Regional Anesthetic
H Radioactive Substance
K Other Diagnostic Substance
N Analgesics, Hypnotics, Sedatives
T Destructive Agent
Z no qualifier
ICD-10-PCS: Procedure Codes
3E0S33Z – Epidural injection of steroid for pain control
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58
ICD-10-PCS 3E033Z converts approximately to ICD-9:
ICD-9-CM 76.96 Injection of therapeutic substance into temporomandibular joint-- OR --ICD-9-CM 81.92 Injection of therapeutic substance into joint or ligament-- OR --ICD-9-CM 82.94 Injection of therapeutic substance into bursa of hand-- OR --ICD-9-CM 83.96 Injection of therapeutic substance into bursa
-- WITH --ICD-9-CM 99.23 Injection of steroid
ICD-10 vs. ICD-9 Procedure Codes
3E0S33Z – Epidural injection of steroid for pain control
