Common Radiology Diagnoses: ICD-9 to ICD-10 Mapping
PERFORMANCE THAT MATTERS
NUMBER OF CODES
14,000
ICD-9 DIAGNOSIS CODES
69,000
ICD-10 DIAGNOSIS CODES
CODE STRUCTURE
ICD-9-CM CODE FORMAT
XXX
XX
CATEGORY
ETIOLOGY, ANATOMIC SITE, MANIFESTATION
3 TO 5 CHARACTERS FIRST DIGIT IS NUMERIC OR E OR V ALL OTHER DIGITS ARE NUMERIC
ICD-10-CM CODE FORMAT
XXX
XXX
X
CATEGORY
ETIOLOGY, EXTENSION ANATOMIC SITE, MANIFESTATION
1 TO 7 CHARACTERS FIRST DIGIT IS ALPHA ALL DIGITS EXCEPT SECOND ALPHA OR NUMERIC
ICD-10 HISTORY
ICD-9-CM ADOPTED FOR HOSPITAL USE
1988
WORLD HEALTH ORGANIZATION ADOPTS ICD-10
1996
CMS PROPOSED RULE TO ADOPT ICD-10 OCT 2011
2009
CMS DELAYS IMPLEMENTATION
ONE YEAR
2014
IMPLEMENTATION OCTOBER 1
1979
ICD-9-CM ADOPTED FOR PHYSICIAN USE
1994
HIPAA LEGISLATION INTERRUPTS US ICD-10 ADOPTION
2008
CMS FINAL RULE TO ADOPT ICD-10
OCT 2013
2013
CONGRESS DELAYS IMPLEMENTATION
ONE YEAR
2015
Common Radiology Diagnoses: ICD-9 to ICD-10 Mapping
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Radiology Diagnoses: ICD-9 to ICD-10 Mapping
Introduction ................................................................................................. 1 Most Common ICD-9 Radiology Codes and ICD-10 Documentation Issues ............. 3
Fractures .................................................................................................... 4 Injuries ........................................................................................................ 6 Common Diagnoses for CT Scans..............................................................7 Common Diagnoses for MRIs ..................................................................... 7 Specificity in Diagnosing Neoplasms .......................................................... 8 Hematuria and Cystitis..............................................................................10
Introduction
ICD-10 CM coding for radiology needs increased levels of specificity that should be included in physician documentation. This document provides an overview of the top diagnosis codes for radiology and the critical changes in ICD-10 that may impact coding and claim submission. The table on the next page shows 3 categories of changes that impact documentation:
1) Diagnoses that require specificity that must be included before claims can be submitted for payment. If a coder receives documentation without the specificity, it must be returned to the provider for additional information. This category is highlighted in red.
2) Diagnoses that request specificity, but "unspecified" or "other" codes are available as a default. Because the intention of ICD-10 is to capture additional detail, it is unclear whether payers will accept "unspecified" codes or if they will be denied or delayed. Therefore, we encourage providers to include the detail in their documentation; the claim will only be returned to the provider in the event of a denial from the payer. This category is highlighted in yellow.
3) Conditions which generally provide a straightforward 1-to-1 transition from ICD-9 to ICD-10. No change to the documentation is required. This category is highlighted in green.
Following the table is an overview of top radiology codes and the documentation issues present with ICD-10. Subsequent pages highlight the top diagnoses and the specific documentation requirements and issues for converting from ICD9 to ICD10.
1
ICD10 Change Condition
Encounter/Episode of Care
Critical: Must be Included in
Documentation
Fracture Type
Site Specificity
Laterality
Important: Codes provide "Unspecified" option but lack of specificity may result in delayed
or denied payments by
payor.
Primary/Post Traumatic/ Secondary
Type of Tear
Patient History
Artery and Chest wall specificity
Ulcer Stage
Identification of pregnancy term
Disease Type
Acute V Chronic
1-to-1 conversion from ICD9 to ICD10;
no additional documentation
required
Normal or C-section birth/delivery
Calculus of gallbladder or kidney
Documentation Requirements Episode of care must be included for injuries, poisonings and other conditions. Designations include initial, subsequent, sequela. There is no "not otherwise specified" or "unspecified" option; the code must include the episode of care to be complete.
Additional details related to fracture type must be included, such as whether the fracture is open or closed, as well as details about the healing phase whether healing is routine or with complications such as delayed healing, nonunion or malunion. Open fractures should include the Gustillo open fracture classification. There is no "not otherwise specified" option.
Greater level of specificity required, including: * Specific area of limb (calf, ankle, etc) * Specific quadrant of breast or area of chest wall Unspecified codes are available. Identify right/left/bilateral/unilateral limb, body location when available. Unspecified codes are available. Conditions such as osteoarthritis, urethritis, and other UTI diagnoses should include whether it is primary, secondary, or posttraumatic. Type of tear needed. Examples for cartilage/meniscus (buckethandle, peripheral, complex) or rotator cuff (incomplete/complete). "Unspecified" and "Other" codes are available. Neoplasm screening should include applicable patient history resulting in need for service
With acute myocardial infarction, chest wall (anterior, inferior) and artery (circumflex coronary, descending coronary artery) should be included. The codes allow for "other sites" and "unspecified site." Pressure ulcers should be categorized based on stages from National Pressure Ulcer Advisory Panel (NPUAP) stages 1-4.
Issues related to pregnancy should identify the trimester. Type and origin of the disease should be included for diagnoses such as hypertension, COPD, and hyperlipedemia. Conditions such as respiratory or digestive orders should be designated as "acute" or "chronic"
1-to-1 conversion; no additional documentation required
1-to-1 conversion; no additional documentation required
2
Most Common ICD-9 Radiology Codes and ICD-10 Documentation Issues
ICD-9
Episode Acute/
Code ICD-9 Description Laterality of Care Chronic
V76.12
Screening Mammogram
ICD-10 Documentation Issues
Anatomical Site Specificity
Patient History
X
Injury How / What
Pregnancy Trimester
Other
Routine Screening vs diagnostic (presenting
w/symptoms);
Inconclusive mammogram
Chest pain, 786.50 unspecified
X -
X
Postoperative,
Anterior, wall, central or neoplasm
musculoskeletal related, Post-
thoracotomy
729.5 Pain unspecified limb X
X - Upper arm/forearm Thigh/lower leg
Hands, fingers, foot, toes
Unspecified Pleural 511.9 effusion
X
793.19
Nonspecific abnormal finding of lung
X
coin lesion, solitary
X
pulmonary nodule
784.0 Headache
x
Post-
X
traumatic;
Allergies;
medications
789.00
Abdominal pain, unspecified
X
X - Upper/ lower quadrant
Pelvic or perineal Epigastric
Periumbilical
786.05 Shortness of breath
Lump or mass in 611.72 breast
X
X
Head injury, 959.01 unspecified
X
X
X
X
V76.11
Screening Mammogram/high risk
x
Family HX
Fitting/adjust of V58.81 vascular catheter
611.89
Other specified disorders of breast
X
X
Other diseases of the 518.89 lung
X
Pain in joint, pelvic 719.45 region & thigh
X
X
719.46 Pain in joint, lower leg X
X
786.2 Cough
959.09 Injury of face and neck
X
X
X
X
X
X
precordial, ischemic, pressure, discomfort, tightness, painful respiration
underlying condition: Influenza, tuberculosis, malignancy
Identify neoplasm if applicable
Description (cluster, tension, vascular) & duration & frequency
Tenderness, generalized, severe w/abdominal rigidity
In general, this is a 1-to-1 conversion. No longer distinguish breast mass v nodule
Loss of consciousness
This is a 1-to-1 conversion No longer distinguish breast mass v nodule;
specify symptoms or disorder (e.g. infection, lactation)
Chronic obstructive w/associated conditions; respiratory failure
Specific code assigned to each joint Specific code assigned to each joint Tobacco use; w/hemorrhage; bronchial Head v. face; superficial v. open wounds
3
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