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50 Shades of ICD-10

50 shades is taking the world by storm—50 shades of ICD-10, that is. Get down and dirty with us as we sum up the most complex ICD-10 characteristics.

Lauren Milligan
5 min read
February 19, 2015
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While ICD-10 may not make you hot, it probably gets you pretty bothered. Finding an ICD-10 code that’s a perfect match for a particular ICD-9 code is like trying to find a shade of paint that’s the exact same color as your new gray throw pillows. You might assume you can simply tell your friendly hardware store associate you’d like a can of gray paint for your living room, and boom—all done. Easy peasy. But when you actually make it to the swatches aisle, you inevitably find yourself in a deep discussion on the differences between dawn gray, olive-gray, pearl gray, and castor gray—not to mention gull gray, light gull gray, iron gray, neutral gray (yep, it can get more neutral than plain ol’ gray), mouse gray, and French gray (oui, oui). Forget about 50; in fact, there are actually more than 100 shades of gray (take that, E.L. James). You stand frozen as the paint swatches swirl before you in a kaleidoscope of gray tones—taunting you and your indecision.   

Okay, so maybe that’s a stretch. Picking one out of a hundred paint colors isn’t quite as difficult—or as complicated—as switching to a new set of diagnosis codes. But that’s really because, when it comes to ICD-10, you’ve got a lot more on the line than feng shui and fashion. Plus, you’ve got a big to-do list to tackle, including:


We know that’s a lot to manage, but there’s an excellent reason for all of those preparatory efforts: the new-and-improved code set is extensive, detailed, and complex. If you’ve been reading our blog for a while, you’re already up-to-date on all things ICD-10. But if all this talk about the transition away from ICD-9 is news to you, here’s a quick breakdown of the most notable ICD-10 characteristics.

Codes for Days

Much like Home Depot presents you with a plethora of paint options, ICD-10 offers you many, many coding options. ICD-9 only has about 13,000 codes. But ICD-10—ICD-9’s bigger, badder, all grown-up sibling—has more than five times the options, or about 68,000 codes. No longer can you simply indicate that a patient presents with, say, a pressure ulcer, by selecting one of the nine codes available in ICD-9. With ICD-10, you must choose from 150 codes, each of which designates specific locations and stages for that one condition. Another example: angioplasty, which has only one ICD-9 code, now has 854. That’s right—count 'em with me: ICD-10 has 854 angioplasty codes to specify body part, approach, and device.

Pro tip: Look out for an increase in combination codes, too (oh, and you also may need to record multiple codes for a single condition).

Characters Welcome

So, where did all these extra codes come from, you ask? The CMS website Road to 10 has the answers to satisfy your curiosity, but I’ll summarize a few golden nuggets here. To bring all these extra codes into existence, the World Health Organization started by adding some pretty colorful characters to the cast. While ICD-9 codes were only three to five characters long, ICD-10 codes can include as many as seven characters. The great thing about these extra characters is that your codes will now be much more specific when it comes to:

  • Category of diagnosis
  • Crucial clinical details—like related etiology, anatomic site (including laterality), or severity
  • Information on the episode of care

As Martha Stewart would say, that’s a good thing.

Like ICD-9, the codes are alphanumeric (and the decimal comes after the third character), but don’t get too comfortable, because there are some key differences, too. Check out the new rules for the code structure:

  • Character one: Alpha
  • Character two: Numeric
  • Characters three through seven: Alpha or numeric

Keep in mind that the seventh character isn’t mandatory, but instead serves as an optional mechanism for providing more information about certain encounters. The use of seventh characters is especially common in chapter 19 (Injury, poisoning and certain other consequences of external causes). To learn more about each of the seven characters, read this blog post.

“X” Marks the Spot

Can’t fill in one of the characters? Don’t leave it blank. Each character in an ICD-10 code is like a coordinate on a map, so if you want to find your treasure (i.e., your reimbursements), you’ve got to use an “X” placeholder for each spot you don’t fill. According to, this “dummy digit” comes into play “to allow for future expansion and/or to fill out empty characters when a code contains fewer than 6 characters and a 7th character applies.” If you need to use it—but don’t—then your code is invalid, meaning you won’t get paid. We advise you to learn the appropriate usage so you don’t lose your booty. 

If the thought of transitioning to ICD-10 (or going to see 50 Shades of Grey) makes you want to hyperventilate, we get it (and here’s a paper bag, just in case). Making the switch to a brand new—and much larger—code set is a pretty enormous undertaking. But making sure you understand all the gray areas of the new code set is the first step toward a successful transition. Looking for more ICD-10 prep tips? We’re here to help you chip away at this important task. Our first recommendation: Register for our upcoming webinar to learn what should be on your ICD-10 preparation checklist.


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