If you were practicing medicine in October 2015, you undoubtedly remember the tremendous change associated with the transition from ICD-9 to ICD-10. All HIPAA-covered entities, including healthcare providers, healthcare clearing houses, electronic health record (EHR) vendors, and other business associates, were required to start using ICD-10 for medical billing and clinical documentation. ICD-10 is the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) from the World Health Organization (WHO). Healthcare providers from all over the world were already using ICD-10 when those from the United States were required to do so.
In this article, we explore some of the history behind the switch from ICD-9 to ICD-10 and share the 25 most common medical diagnoses in 2021.
As you know, ICD is a diagnostic tool used for clinical, health management, and epidemiologic purposes, enabling analysis, assessment, and comparison of the incidence and prevalence of medical conditions, morbidity, and mortality data across the world. ICD-10 includes updated codes for signs and symptoms, diseases, procedures, abnormal findings, external causes of injury or disease, and social circumstances. Importantly, ICD-10 is much more than a simple updated version of ICD-9. Rather, it’s essentially a complete revamp and modernization of medical classifications, including nearly 70,000 new codes and more detailed 7-digit alphanumeric codes. 1,2,3
ICD-10 uses current medical terminology via an expanded coding format, enabling healthcare providers to capture greater detail within the code, providing much more specific information about the diagnosis. It is much more flexible than ICD-9, reflecting medical advances, new technologies, and diagnoses, while including more information about ambulatory and managed care as well as accidents and injuries. ICD-10 allows much greater specificity, including the ability to add laterality, combine diagnosis and symptom codes, and improve identification of conditions and disease processes to further promote research. 1,2,3
Further, this transition was required, by law, for covered entities—such as physicians, other healthcare providers, EHR vendors, and more–under the Health Insurance Portability and Accountability Act (HIPAA). It’s also mandatory for healthcare providers to bill using ICD-10 codes to receive payment for their services; otherwise, payment will be denied. Technically, the HIPAA ICD-10 code requirements apply solely to electronic transactions. Yet using ICD-10 for electronic submissions and ICD-9 for manual submissions would be extremely burdensome regarding time, duplicative efforts, error risk, resources, and other costs. 1,2,3
To ensure optimal quality and managed care for your patients, it’s helpful to gain insight into trends in ambulatory care in the United States and in your area of the country. Identifying and tracking specific sets of patient populations is also key for fulfilling quality improvement measures as part of your practice’s Merit-based Incentive Payment Systems (MIPS) score.
Practice Fusion enables you to create custom reports of your practice’s patient populations based on using different combinations of clinical and demographic criteria along with the ability to save your customized reports for repeated generation. Practice Fusion’s Patient List Report provides several search parameters, including:
It’s important to identify the kinds of conditions most encountered in ambulatory practices, particularly those specializing in primary care, enabling providers to determine the context for where they should focus disease interventions.
The most common ICD-10 diagnoses seen by U.S. primary care specialists include essential (primary) hypertension (I10); type II diabetes mellitus without complications (E11.9) and other specified diabetes mellitus without complications (E13.9); and hyperlipidemia, unspecified (E78.5). 4,5
It’s illustrative to compare the previous ICD-9 descriptions and codes against the new ICD-10 describers and codes or these frequent diagnoses regarding specificity and updated medical terminology:
The following chart shows 25 of the most common ICD-10 diagnoses as submitted by primary care specialists as well as the original ICD-9 codes. 4,5 Regarding numerical rank, these are not in any particular order, since different sources may list slightly different numerical rankings.
However, overall, the same diagnoses do tend to rise to the top. For example, some primary care practitioners may report more cases of essential hypertension than type II diabetes mellitus, whereas for others, the reverse may be true. Yet importantly, the following currently represents the most frequently reported ICD-10 codes and shows clear trends regarding primary cares’ patient populations and where disease interventions and proactive prevention methods should be focused.
unspecified essential hypertension
essential (primary) hypertension
diabetes mellitus without mention of complications, type II or unspecified type, not stated as uncontrolled
type II diabetes mellitus without complications
other specified diabetes mellitus without complications
other and unspecified hyperlipidemia
(*There are more specific ICD-10 codes available, if applicable, e.g., pure hypercholesterolemia [E78.0].)
routine general medical examination at a healthcare facility
encounter for general adult medical examination without abnormal findings
chronic airway obstruction, not elsewhere classified
chronic obstructive pulmonary disease (COPD), unspecified
(*There are more specific ICD-10 codes, if applicable, e.g., chronic obstructive pulmonary disease with acute lower respiratory infection [J44.0]; an additional code is required to identify infection type.)
Paroxysmal atrial fibrillation
Persistent atrial fibrillation
Chronic atrial fibrillation
Unspecified atrial fibrillation
abdominal pain, unspecified site
abdominal pain, unspecified
(*There are more specific ICD-10 codes, if applicable, e.g., acute abdominal pain [R10.0)], upper abdominal pain, unspecified [R10.10], right upper quadrant pain [R10.11], left upper quadrant pain [R10.12])
coronary artery atherosclerosis of unspecified type of vessel, native, or graft
*no equivalent in ICD-10; more clinical specifics are required to determine proper ICD-10 code. (However, one of the most frequent ICD-10 codes used by primary care specialists is “atherosclerotic heart disease of native coronary artery without angina pectoris” [I25.10].)
need for prophylactic vaccination and inoculation against unspecified single disease
encounter for immunization (ICD-10 code required first for any routine childhood examination.)
urinary tract infection, site not specified
urinary tract infection, site not specified (*Required to use an additional ICD-10 code to specify cause of infection [B95-97].) (*There are also more specific ICD-10 codes available, if applicable, e.g., acute cystitis without hematuria [N30.00], acute cystitis with hematuria [N30.01], interstitial cystitis chronic without hematuria [N30.10].)
anxiety state, unspecified
anxiety disorder, unspecified (*There are more specific ICD-10 codes, if applicable, e.g., generalized anxiety disorder [F41.1].)
depressive disorder, not elsewhere classified
major depressive disorder, single episode, unspecified (*There are more specific ICD-10 codes, if applicable, e.g., major depressive disorder, single episode, mild [F32.0], major depressive disorder, single episode, moderate [F32.1], etc.)
gastroesophageal reflux disease without esophagitis
gastroesophageal reflux with esophagitis
pain in unspecified limb (*There are more specific ICD-10 codes, if applicable, e.g., pain in right arm [M79.601], pain in left arm [M79.602], pain in arm, unspecified [M79.603], pain in right leg [M79.604], pain in left leg [M79.605], pain in leg, unspecified [M79.606], etc.
chest pain, unspecified
chest pain, unspecified (*There are more specific ICD-10 codes available, if applicable, e.g., chest pain on breathing [R07.1] or pleurodynia [R07.81].)
other malaise and fatigue
neoplasm (malignant) related fatigue (*Required to first code the associated neoplasm.)
postviral fatigue syndrome
acute upper respiratory infections of unknown site
acute upper respiratory infection, unspecified
other specified diseases of the upper respiratory tract
pneumonia, organism unspecified
pneumonia, unspecified organism (*Required to code associated influenza first, if applicable [J09.X1, J10.0-, J11.0-].)
acute bronchitis, unspecified (There are also more specific ICD-10 codes, if applicable, e.g., acute bronchitis due to parainfluenza virus [J20.4], acute bronchitis due to respiratory syncytial virus [J20.5], acute bronchitis due to rhinovirus [J20.6], etc.)
pain in joint, lower leg
pain in right knee
pain in left knee
pain in unspecified knee
congestive heart failure, unspecified
heart failure, unspecified (*There are also more specific ICD-10 codes, if applicable, e.g., left ventricular failure [I50.1], acute systolic (congestive) heart failure [I50.21], chronic systolic (congestive) heart failure [I50.22], etc.)
(*There are more specific ICD-10 codes, if applicable, e.g., congenital hypothyroidism with diffuse goiter [E03.0] or congenital hypothyroidism without goiter [03.1].)
Reviewing such data can be critical in collaborative decision-making with patients at the center of and as part of the discussion. This small example shows the value of taking advantage of ICD-10’s specificity when diagnosing patients and billing visit encounters via Practice Fusion enabling you to generate and evaluate such data to learn more about your patients’ needs, to ensure optimal quality of care, and to fulfill quality improvement measures critical to your patients.
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