Medical
International Statistical Classification of Diseases and Related Health
Problems Version 10 Info
What is Medisoft ICD-10?:
ICD 10
is the new diagnosis classification system developed by the World Health
Organization, and is being
adopted by the American
Medical Association and required
by Medicare for national implementation.
How Will ICD-10 Be Used?
ICD-10 will be used by
both hospitals and institutions (UB04 billing), as well as individual
doctors and other medical professionals providing service and billing
electronically or on the CMS 1500 form. There several
sub-categories of ICD-10:
-
ICD-10-CM
(diagnoses) will be used by all providers in every health care setting
-
ICD-10-PCS
(procedures) will be used only for hospital claims for inpatient
hospital procedures. ICD-10-PCS
is
for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7
alphanumeric digits instead of the 3 or 4 numeric digits used under
ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more
specific and substantially different from ICD-9-CM procedure coding.
- ICD-10-PCS will
not be used on physician claims, even those for inpatient visits
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Medisoft
v19 will be compliant and
readiness can be purchased now thru our Medisoft Network Professional
subscription plan.
ICD-10
Transition Timeline
October
1, 2011 –
ICD-9-CM and ICD-10 code sets freeze
October
2012 – Limited
code updates to both ICD-9-CM and ICD-10 code sets to capture new
technology and new diseases
October
1, 2013 –
Compliance date for implementation of ICD-10-CM (diagnoses) and
ICD-10-PCS (procedures)
Other
Dates Based on Date of Service
–
Implementation
of the ICD-10 code sets will expand the number of diagnosis codes from
14,000 to approximately 69,000 and the number of
inpatient procedure codes will grow from almost 4,000 to an estimated
72,000.
The
new coding system will require more specific document from physicians
about the care provided to patients. For example, ICD-10 has added
"laterality" (i.e. distinguishing between left and right) to its
structure.
Thus,
not only will physicians will need to document this detail, but coders
and other individuals that work with ICD codes will need to understand
basic anatomy and physiology.
The transition to ICD-10
is occurring because ICD-9 produces limited data about
patients’ medical conditions and hospital inpatient
procedures. ICD-9 is 30 years old, has outdated terms, and is
inconsistent with current medical practice. Also, the structure of
ICD-9 limits the number of new codes that can be created, and many
ICD-9 categories are full.
Benefits
of ICD-10
ICD-10
provides more specific data than ICD-9 and better reflects current
medical practice. The added detail embedded within ICD-10 codes informs
health care providers and health plans of patient incidence and
history, which improves the effectiveness of case-management and
care-coordination functions. Accurate coding also reduces the volume of
claims rejected due to ambiguity. Here the new code sets will:
- Improve operational
processes across the health care industry by classifying detail within
codes to accurately process payments and reimbursements.
- Update the terminology
and disease classifications to be consistent with current clinical
practice and medical and technological advances.
- Increase flexibility
for future updates as necessary.
- Enhance coding
accuracy and specificity to classify anatomic site, etiology, and
severity.
- Support refined
reimbursement models to provide equitable payment for more complex
conditions.
- Streamline payment
operations by allowing for greater automation and fewer payer-physician
inquiries, decreasing delays and inappropriate denials.
- Provide more detailed
data to better analyze disease patterns and track and respond to public
health outbreaks.
- Provide opportunities
to develop and implement new pricing and reimbursement structures
including fee schedules and hospital and ancillary pricing scenarios
based on greater diagnostic specificity.
- Provide payers,
program integrity contractors, and oversight agencies with
opportunities for more effective detection
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Sample
code2 |
OLD
ICD-9 Code
813.15, Open fracture
of head of radius |
NEW
ICD-10 Code
S52123C, Displaced
fracture of head of unspecified radius, initial encounter for open
fracture |
General
Equivalency Mappings (GEMs)
General
Equivalence Mappings (GEMs) attempt to include all valid relationships
between the codes in the ICD-9-CM diagnosis classification and the
ICD-10-CM diagnosis classification. The tool allows coders to look up
an ICD-9 code and be provided with the most appropriate ICD-10 matches
and vice versa. Although, GEMs are not a "crosswalk" and are merely
meant to be a guide. Users should exercise clinical judgment when
choosing the appropriate code or codes to map between ICD-9 and ICD-10
in either direction. The GEMs are a very useful tool, but it is not a
substitute for a complete system change over to ICD-10.
Additional
Resources:
13 Tips to Get
Started With ICD-10 http://www.beckershospitalreview.com/racs-/-icd-9-/-icd-10/13-tips-to-ease-the-icd-10-switch.html
Top ICD10 Myths and Facts: http://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD-10MythsandFacts.pdf
ICD-10 FAQ's: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10FAQs2013.pdf
ICD-10 Introduction: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10Introduction.pdf
ICD-10 Basics: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10BasicsforMedicalPractices.pdf
Checklist for Small to Medium sized Medical Practices: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10SmallMediumChecklistTimeline.pdf
Checklist for Large Practices: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10LargePracticesChecklistTimeline.pdf
Timeline for ICD-10 Implementation for Small To Medium Sized HealthCare
Offices: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10SmallMediumTimelineChart.pdf
Timeline for ICD10 Implementation for Large Practices: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10LargePracticesTimelineChart.pdf
Guide for Implementing ICD-10 In a Small to Medium Sized Medical
Practice: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10SmallMediumPracticeHandbook.pdf
Guide for Implementing ICD-10 In Large Medical Specialty Clinic: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10LargePracticesGuide.pdf
ICD-10 Training Webinar From CMS
and AAPC:
ICD-10 Code A Thon Webinar from CMS and AAPC; this section was
presented by CMS: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/CMSICD-10Overview.pdf
ICD-10 Code A Thon Webinar from CMS and AAPC; this section was
presented by the AAPC; http://www.cms.gov/Medicare/Coding/ICD10/Downloads/AAPCICD-10WillChangeEverything.pdf
ICD-10 Code A Thon webinar from CMS and AAPC; Official Transcript:http://www.cms.gov/Medicare/Coding/ICD10/Downloads/TranscriptMay92011.pdf
Additional Resources:
The 5 Phases of ICD-10 Implementation
for Physician Practices
The ICD-10 Transition: A Phased,
Measured Approach for Physician Practices
ICD-10 and Gunga Galunga, The Gift That
Keeps on Giving
ICD-10 and the 5 Stages of Grief
It's About Time
Let the Games Begin!
Now is Not the Time to Implement, Now is
the Time to Learn
Relax
The Feds Got it Right....This Time
Why is ICD-10 So Hard to Get Done? I'm
Livid
Giving Thanks to the ICD-10 Moms
Twas the Night Before ICD-10
They Burned the Boats!
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