Health Information Management

Teaching ICD-10-CM/PCS in an ICD-9-CM world

JustCoding News: Outpatient, November 16, 2011

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by Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I

As educators, we have a responsibility to prepare our students for successful careers in coding and health information management. With fewer than two years until ICD-10-CM/PCS goes into effect, we are in the unique position of having to teach students to use both ICD-9-CM and ICD-10-CM/PCS code sets. They need certification in ICD-9-CM and get their first jobs, but also be prepared to transition smoothly to ICD-10-CM/PCS in October 2013.

Here are some ideas for helping students learn for a job now (or soon) while also helping them feel confident that they will be able to step into ICD-10-CM/PCS without starting their education over again from scratch.

Diagnosis coding
The steps to coding are identical for both ICD-9-CM and ICD-10-CM diagnosis codes:
• Read the documentation
• Find the key terms
• Look up the key terms in the index
• Confirm the code(s) in the tabular listing to determine which to report

The only difference is that the code reported will look different.

Many of the official coding guidelines are the same in both ICD-9-CM and ICD-10-CM. Educators must teach students to refer to the guidelines in the front of the codebook, and this learning process instills some basics. The good news is that many of the basics remain the same so students will not need to relearn them. For example, the official guidelines for reporting infectious and parasitic conditions are the same in both code sets.

The parts of the book are the same. The official guidelines, alphabetic index, hypertension table, neoplasm table, table of drugs and chemicals, index to external causes, and the tabular list are present in both books and code sets.

Many differences, such as the inclusion of laterality in ICD-10-CM codes, are logical. For example: In ICD-9-CM, coders report 354.0 for carpal tunnel syndrome. In ICD-10-CM, coders will chose between G56.01 (carpal tunnel syndrome, right upper limb) and G56.02 (carpal tunnel syndrome, left upper limb). When coders understand this simple change, they will be less afraid of the transition.

The chapters are very similar. The one major change is that Chapter 6, Diseases of the nervous system and sense organs in ICD-9-CM becomes three chapters in ICD-10-CM:

  • Chapter 6, Diseases of the nervous system
  • Chapter 7, Diseases of the eye and adnexa
  • Chapter 8, Diseases of the ear and mastoid process

This separation actually makes it easier to teach these specialties. Otherwise, the two lists of chapters match up very closely.

By helping students see the similarities between the two code sets, we will support the value of the learning they are experiencing now. In 2013, they will still have a learning curve to transition to ICD-10-CM, but they will find the curve easier to navigate.

Procedure coding
The changes from ICD-9-CM volume 3 to ICD-10-PCS are more extensive. However, educators can do some things to help reduce anxiety.

Start by reminding students everything that you have already taught them. A good introduction may include a statement such as, “This is why we made you take anatomy and physiology and medical terminology classes before coding.” In other words, you are giving them the complete education—the knowledge and the skills to be successful in 2012 (before the implementation of ICD-10-PCS) as well as after the implementation in October 2013.

Think of building ICD-10-PCS codes as you might a Build-A-Bear Workshop®. Coders must construct an ICD-10-PCS code rather than simply look it up. However, if coders take one component at a time, they will be less intimidated.

When you turn to the Tables section, which replaces ICD-9-CM volume 3’s tabular list, break the code down into one character at a time before coders have a chance to panic. Let them identify what detail is needed, find it in the documentation, and then find the correct character.

Relay the fact that the body part (character 4 in the ICD-10-PCS Medical and Surgical section) is the same as anatomical site many ICD-9-CM volume 3 codes require. For example, in ICD-9-CM volume 3, code 58.23 represents a biopsy of urethra compared to ICD-10-PCS code 0TBDXZX, which is a diagnostic excision of the urethra through an external approach.

You can also add a medical terminology addendum. In most medical terminology courses, we teach students about word roots. In preparation for ICD-10-PCS, we must add in explanations of root operations to narrow the definition of medical and surgical processes necessary to determine the correct third character.

In addition, physicians will need to document more details regarding the various surgical approaches and devices. We are not adding to the list of terms, but we do need to connect more terms to new classifications.

For example, if we look at the terms ‘biopsy’ and ‘excision’; we just now need to connect the dots between these two terms. A biopsy is a type of excision because the physician is only taking some tissue samples during the procedure. Therefore, in ICD-10-PCS, coders will report a biopsy within its broader classification as an excision. Remind them that the definitions are included in the ICD-10-PCS Coding Manual to support their learning of these additional terms.

Prepare administration for a change to the educational program and begin to massage the credit hours. Whether you teach ICD-9-CM volume 3 coding with ICD-9-CM diagnosis codes or in your procedure coding class with CPT, ICD-10-PCS will no longer fit smoothly into these other coding processes. It should have its own course to properly prepare students to work in an inpatient coding environment. As we all know, this will play havoc with the structure of your school’s program. You will need to write a syllabus for the school, state, and accrediting bodies to approve. The sooner you start this process, the higher quality education you can provide to your students for the transition.

We are teaching at a wonderful time in our industry. The upcoming conversion of your courses will give you the occasion to update and refresh the material. It is certainly a great deal of work; however, teaching is an honorable profession and the reward is having the opportunity to ready educated and qualified new professionals into the industry. And it just might rejuvenate our own attitudes and provide an opportunity for you to rediscover the excitement that comes from learning something new and sharing that knowledge as well.

Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, in an AHIMA-approved ICD-10 trainer. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at

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