Overview of ICD 10 from a Top Medical Billing Company

Overview of ICD 10 from a Top Medical Billing Company

Overview of ICD-10

The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding system used by healthcare providers for classifying diseases, signs and symptoms, patient complaints, abnormal findings, environmental and social circumstances, and external causes of injury, disorders, or diseases, as standardized by the World Health Organization (WHO). The code set includes more than 14,000 various codes and allows for tracking of new diagnoses.

The ICD-10 is an updated and improved version of the ICD-9 code set. Many countries, including the U.S., have adopted this system for use in the healthcare system. The National Center for Health Statistics developed the ICD-10-CM (Clinical Modification) for use in America, and the Centers for Medicare and Medicaid Services (CMS) developed the ICD-10-PCS (Procedure Coding System) to allow a higher level of information for various billing and insurance organizations.

Who is affected by ICD-10?

The ICD-10 alters diagnosis and procedure coding for anyone covered under the Health Insurance Portability and Accountability Act (HIPAA). This code set change will not affect Current Procedure Terminology (CPT) coding for outpatient services. The new ICD-10 codes will be required for use by all healthcare service providers in the U.S., and payers, clearinghouses, providers, and billing services must all comply with this new code set.

To comply, you should develop an implementation plan that includes a detailed timeline, budget, and organization assessment. Also, consult with a practice management software company and billing service company to assure compliance.

Major Changes from ICD-9 to ICD-10

There are many changes from ICD-9 to ICD-10. With annual updates, the ICD-10 codes are very different from the ICD-9. Because of this, substantial system and procedural changes are necessary in order to be ready for ICD-10. This new code set allows for a better way to receive reimbursement for services and supplies rendered. Also, ICD-10 allows for improved care, better public health reporting, enhanced quality management, and ease for research.

How Will ICD-10 Be Used?

ICD-10-CM diagnoses are to be used by all healthcare providers, and ICD-10-PCS procedures should only be used for hospital claims for services done inpatient. They cannot be used on physician claims, however. HCPCS and CPT codes will continue to be used by provider and ambulatory services.

When will ICD-10 be Required?

As of October 1, 2014, there has been a delay in the compliance date. According to a CMS spokesman, the new compliance date is October 1, 2015 for both ICD-10-CM and ICD-10-PCS code sets. Ambulatory services after this date must use the new ICD-10-CM diagnosis codes. Inpatient discharges that occur on or after this date should use the new codes alkso.

ICD-9 vs. ICD-10

There are many differences between the ICD-9 and ICD-10 code sets. The new code set will expand the number of diagnosis codes from around 14,000 to 70,000. Also, the inpatient procedure codes increase from 4,000 to 72,000, making coding more specific and unique. The new coding system requires detailed documentation from providers regarding patient care. Therefore, physicians and practitioners must document visits and services in detail, and coders have to have a comprehensive understanding of anatomy and physiology.

ICD-10 Conversion Benefits

There are many aspects of billing and coding that will improve with the conversion from ICD-9 to ICD-10. This includes improved data available for:

Evaluating safety, quality, and efficacy of care.

Improving financial, clinical, and administrative performance.

Developing payment systems and processing claims.

Conducting epidemiological studies, research, and clinical trials.

Preventing and/or detecting healthcare abuse and fraud.

ICD-10 Resources

There are many clinical and trade organizations that offer ICD-10 information, checklists, and educational resources. The healthcare organization manager or medical care provider should check various websites for available resources. These include the CMS website: www.cms.gov/ICD10

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