ICD-9 V-Codes and E-Codes Versus ICD-10 Chapter 19 and Chapter 20
In the transition from ICD-9 to ICD-10, code length has expanded from five to seven positions, and the total existing codes from 13,000 to 68,000, with greater specificity and modernized, more consistent terminology, as well as the introduction of combination codes to allow for fewer codes to be used to describe a condition. This transition was necessary to incorporate the dramatic changes in medicine in the last 25 years and to include new conditions and treatments that have been discovered. The ICD-10 code set is much more flexible and better designed to capture more detailed information. Specific changes in ICD-10-CM Chapters 19 and Chapter 20 compared to ICD-9 V-Codes and E-Codes are:
- Injuries are categorized by affected body part rather than the type of injury. The first axis of classification is the body part affected, followed by the second axis of classification that indicates the type of injury.
- Greatly expanded codes in ICD-10 include much more detail, for example, fractures of each level of vertebrae are coded separately.
- Category title changes to reflect current medical terminology, for example, displaced and nondisplaced.
- Most categories in Chapter 19 have a seventh character requirement for each applicable code to report if the encounter is initial, subsequent or sequela. If the code does not contain six characters, an X place holder can be used before placing the seventh character.
- Laterality is used for most Chapter 19 codes including right, left, bilateral, or unspecified.
- ICD-10 marks a distinction between burns and corrosions, and burns are now classified by heat source. An external cause code is used in ICD-10 with burns and corrosions to identify the source and intent of the burn as well as the place where it occurred.
- Traumatic fractures require documentation of specific anatomical site and the type of fracture. Seventh character extensions capture information about closed or open fractures. Open fractures require documentation of Gustilo classification. Subsequent care requires documentation of routine/delayed healing and malunion or nonunion. ICD-9 had one code for reporting nonunion or malunion; ICD-10 has hundreds of options.
- Changes in Chapter 20 include external clause codes being assigned for each encounter, not just the initial treatment. This is accomplished with the new seventh-character extensions.
- Other expansions in Chapter 20 of ICD-10 include increased specificity at the fourth, fifth, and six character levels (for example, fall from playground equipment in ICD-9 has been expanded to include playground slide, swing, jungle gym, or other in ICD-10).
- Changes in terminology in ICD-10 include assault instead of homicide, intentional self-harm instead of suicide, and bitten by or contact with or struck by instead of stings. There is further classification of drowning in ICD-10 into bathtub, swimming pool, or natural water.
- In ICD-9, the emphasis was on the activity being performed at the time of injury, whereas in ICD-10 this information is provided by the external cause activity code.
- ICD-10 external cause codes for unintentional or intentional poisoning are less detailed than ICD-9.
- Transport accident victims are grouped by type in ICD-10 (for example, pedestrian, pedal cyclist, or car occupant), whereas in ICD-9 the grouping was by vehicle type (motor vehicle, railway, water transport).
Relationship Between ICD-10-CM Chapter 19 and Chapter 20 Codes
Chapter 20 external cause codes are supplementation to the application of Chapter 19 diagnosis codes and are not mandatory. Voluntary reporting of Chapter 20 codes is encouraged and is intended to provide valuable data for injury research and to formulate injury prevention strategies. Chapter 19 codes capture the cause and intent of the injury. Chapter 20 codes provide additional information about the activity of the person at the time of injury, the place of injury, and the status of the patient. Chapter 20, external causes of morbidity, can never be listed as the principal diagnosis.
- V Codes
- External Cause
- Chapter 20
- Chapter 19