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UNDERSTANDING THE BASICS OF ICD-10
Article compiled by: Rendani Tendane-Medical Coding Consultant (SAMA Coding Division)
ICD is an abbreviation of International Statistical Classification of Disease and Related Health Problems, thus the diagnostic coding structure and is used together with the procedural coding structure.
Definition: Translation of medical diagnose into coding form. The codes are alpha numeric format e.g. A09.9-Gastroenteritis and colitis of unspecified origin. The ICD-10 codes consist of 3-5 Characters and remember a dot is not character and should be coded to full specificity.
Background
ICD-10 was endorsed by 43rd World Health Assembly 30 years ago (1990), it came in to use by WHO (World Health Organisation) in 1994. WHO inherited ICD on its 6th revision. There are about 42 000 ICD-10 codes and the World Health Organisation is responsible for updating and maintaining ICD-10 since they are the owners of ICD (the country should comply with their rules and norms).
The ICD-10 licence for South Africa was issued by WHO to the South African Department of Health in 1996 and it was implemented in July 2005 under the auspice of the National ICD-10 Implementation Task Team of the Department of Health.
The Benefits of ICD-10
The codes are used for data collection (which provides statistics globally).It helps with improving quality health care (to measure quality health care by verifying the need of care and treatment) and clinical management.
The correct use of ICD-10 codes helps in terms of accurate or proper reimbursement of accounts by the medical schemes and identification of medical trends.
Examples on ICD-10 coding
Example1
4 year old boy slipped and fell while playing soccer at home. An X-ray was done and the report shows he has a Fracture of the shaft of the Femur.
The ICD-10 code for Fracture of Shaft of femur is S72.30 (The 5th character must be coded).
0 is for close fracture and 1 indicate open fracture. A fracture not indicated as closed or open should be classified as closed.
Together with the fracture code an external cause code must be added.
External cause code
Patient slipped and fell while playing soccer-W01.00
The last two digits are for place of occurrence and Activity code.
Example 2
Post-operative complications – These are condition arising from surgical or an medical procedure. T80-T88 and Y83-Y84.
Patient admitted with post-operative wound infection.
T81.4
Y83.9
The challenges of coding
The challenges that coders come across with is lack of Clinical Information from Health care providers e.g. scans tests and scopes are done but no feedback or report is provided, this leads to short payment of accounts due to misusing or over coding the patient.
We are aware that some of the diagnosis Doctors are not allowed to disclose without patient consent as per POPIA (The Protection of Personal Information Act, No 4 of 2013).
The different version of ICD-10
Please note that not all reference to ICD-10 on the internet is referring to the World Health Organisation (WHO) edition of ICD-10. In South Africa, we use the WHO ‘vanilla’ version of ICD-10, with a few local code additions. The SA ICD-10 Master Industry Table (MIT), Jan 2014 (containing all WHO Corrigenda updates until January 2014), is the ONLY official reference list for ICD-10 codes appropriate for use in South Africa.
Our SAMA Products
Electronic ICD-10 browser developed by SAMA. It includes the latest 2014 MIT ICD-10 codes which is the official version of ICD-10 used in South-Africa.
Due to the need amongst the industry SAMA has obtained a licence to produce an ICD-10 diagnostic code browser by the World Health Organisation.
This SAMA stand-alone ICD-10 browser is for those practices and industry role players that do not wish to buy the SAMA eCCSA or the SAMA eMDCM (which now also includes the ICD-10 codes). This is SAMA's first release version.
For SAMA members you can go to our SAMA website www.samedical.co.za , log in on your top right hand corner, once you logged in select SAMA Products then you select ICD-10 electronic browser
For non SAMA members you can go to our SAMA website www.samedical.co.za, select SAMA Products, then you select ICD-10 electronic browser developed by SAMA
See below pricing list.
2020 edition of the Electronic ICD-10 (browser)
(Based on the 2014 ICD-10 Master Industry Table)
Number of copies / licenses - Price per unit 2020
1st Licence for SAMA Members - R 200.00 /licence (VAT Incl)
1st Licence for Non-SAMA Members - R 250.00/licence (VAT Incl)
2nd - Unlimited Licences - R 200.00 /licence (VAT Incl)
NB!! When payment is received a link and activation key will be emailed to download on your PC.
Licence period:
The ICD-10 Browser program has a one year licence period valid from 1 January 2020 to 31 December 2020. Should you purchase the product within this allocated time period, the licence will only remain valid for the remainder of the above mentioned one year period. A grace period of two months will apply, thus the program will remain functional for January and February 2021.
Kindly note that the eMDCM first licence is free for SAMA members.
Please direct any coding queries to our Coding Division on 012 481 2073 or email coding@samedical.org and we will gladly assist you.
SAMA's Medical Coding Division in the Private Practice Department 2020-10-08
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