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brian d cox





We’ll start, with a quick history of the current medical coding system.

        Currently the medical coding uses the ICD-9-CM system. The system is about 30 years old with various updates throughout the years. ICD-9-CM is based on the ICD-9; (Buck, 2009)the 9th revision of the official version of the International Classification of Diseases complied by the World Health Organization (WHO).}. (Buck, 2009, p.444) The ‘CM’ abbreviation identifies the version to be the clinical modification of the ICD -9. The cm version started, as a tool at first, to provide access to medical records for medical research, education, and administration. “Today the system is used to

  • Facilitate payment of health service,
  • Evaluate patient’s use of healthcare facilities (utilization pattern)
  • Study health care costs
  • Research the quality of health care
  • Predict health care trends
  • Plan for the future health care needs (Buck, 2009, p.444)”

The current system has overgrown the capabilities of the original design.

“The four groups (WHO):

  • (CMS) Centers for Medicare and Medicaid services,
  • (NCHS) National Center for Health Statistics,
  • (AHIMA) American Health Information Management Association.
  • (AHA) American hospital Association

are responsible for the in-depth coding principles and practices and have written the ICD-9-CM in a three volume set. (Buck, 2009, p.446)”

We’ll discuss the three volumes of ICD-9-CM below. The explanation should help to understand the current system, and bring up the argument, will the ICD 10 system be easier to use. The ICD-9-CM three volumes are:

  • “Volume 1     Diseases: Tabular list
  • Volume 2    Disease: Alphabetic Index
  • Volume 3    Procedures: Tabular List and alphabetic Index. (Buck, 2009, p.446)”

To further explain the changes that the ICD 10 system imposes I’ll explain what the different volumes contain.    


    Volume I

  • “Contains the disease and condition codes and the code descriptions
  • (V Codes) Supplementary Classification of Factors Influencing Health Status and Contact with Health Services
  • (E Codes) External Causes of Injury and Poisoning
  • Used in assigning diagnostic codes in a inpatient and outpatient setting (Buck, 2009, p.446)”


Volume II

  • “Used in inpatient and outpatient coding for assigning diagnosis codes.
  • Used as the Alphabetic index for Volume 1. (Buck, 2009, p.446)”




Volume III

  • “Hospitals primarily use them.
  • Used to code procedures
  • Contains codes
    • Surgical codes
    • Therapeutic codes
    • Diagnostic procedures (Buck, 2009, p.446)”


ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as from 1994 (WHO, International Classification of Diseases (ICD), para1).
Currently the ICD-9-CM uses three to five digits codes, using (approximately 13,600 (ICD10 facts,para 5)) individual codes, ICD 10 added more digits to the codes, up to seven, concerning some people that number of digits will make the system to complicate to use. In addition to the added digits more (approximately 69,000 (ICD10 facts, para 5)) codes were added to make the coding more specific.

    Using the quote below, as an example of how CMS responded to the question, “Is ICD 10 to complicated”

“The increased number of codes in ICD-10-CM/PCS will make the new coding system impossible to use.FAC

Just as an increase in the number of words in a dictionary. Doesn’t make it more difficult to use, the greater number of codes in ICD-10-CM/PCS doesn’t necessarily make it more complex to use. In fact, the greater number of codes in ICD-10-CM/PCS makes it easier to find the right code. In addition, just as it isn’t necessary to search the entire list of ICD-9-CM codes for the proper code, it is also not necessary to conduct searches of the entire list of ICD-10-CM/PCS codes. The Alphabetic Index and electronic coding tools will continue to facilitate proper code selection. It is anticipated that the improved structure and specificity of ICD-10-CM/PCS will facilitate the development of increasingly sophisticated electronic coding tools that will assist in faster code selection. Because ICD-10-CM/PCS is much more specific, is more clinically accurate, and uses a more logical structure, it is much easier to use than ICD-9-CM. Most physician practices use a relatively small number of diagnosis codes that are generally related to a specific type of specialty. (ICD10 Myths and Facts, 2010, para 4).”


    In addition to the coding aspect, they have super bill concerns as well, as stated in the quote below:



“ICD-10-CM-based super bills will be too long or too complex to be of much use. FACT

Practices may continue to create super bills that contain the most common diagnosis codes used in their practice. ICD-10-CM-based super bills will not necessarily be longer or more complex thanICD-9-CM-based super bills. Neither currently-used super bills nor ICD-10-CM-based super bills provide all possible code options for many conditions. The super bill conversion process includes:

  • Conducting a review that includes removing rarely used codes; and

  • Cross-walking common codes from ICD-9-CM to ICD-10-CM, which can be accomplished by looking up codes in the ICD-10-CM code book or using the General Equivalence Mappings (GEM). (ICD10 Myths and Facts, 2010,para 11)”

    More issues seem to revolve around the code composition. ICD 9-cm codes are mostly numeric, with E and V codes alphanumeric and valid codes of three, four, or five digits. ICD-10,” All codes are alphanumeric, beginning with a letter and with a mix of numbers and letters thereafter. Valid codes may have three, four, five, six or seven digit. (ICD10 facts, para 5)”.

WHO has written a working system, even with all the controversial changes. Below is a quote from the WHO website backing up that statement:



“The success of ICD-10 is unequivocal:

_ 70% of the world’s health expenditures (3,500 Billion USD) ii are allocated using ICD directly for reimbursement and resource allocation;

_ 110 countries that collectively account for 60% of the world’s population use cause of death data coded with ICD for health planning and monitoring in a systematic fashion.

_ ICD-10 is cited in more than 20,000 scientific articles. (WHO International Classification of Diseases (ICD)p.5, para 5)”.

I’ll leave this conversation with that said.




icd 11 revisions. (n.d.). Retrieved 7 26, 2010, from WHO international:

ICD10 facts. (n.d.). Retrieved 7 26, 2010, from aap:

ICD10 Myths and Facts. (2010, 7 25). Retrieved 7 25, 2010, from CMS:

WHO > Programmes and projects > Classifications > International Classification of Diseases (ICD). (n.d.). Retrieved 7 27, 2010, from World Health Organization:








Posted August 1, 2010 by briandcox in new essay