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ICD-10 Coding Changes

ICD-10 is the acronym for International Statistical Classification of Disease and Related Health Problems and the 10 means it is the tenth revision. The publication is a medical classification for coding external causes of injury, social circumstances, complaints, abnormal findings, symptoms, signs and diseases. The document is maintained by WHO, the World Health Organization.

The coding system allows for tracking of new health care concerns and diagnoses and by using sub classifications, the codes can be expanded to more than 16,000 codes. As of October 2013 ICD-10 manual is in effect. The ICD-9 is no longer be used. 

Using the outdated ICD manual will result in insurance claims and other transactions being rejected and the paperwork will have to be submitted using the proper ICD-10 codes. The reasons for the ICD-10 coding changes were brought about by the lack of specifics and detail for diagnostics, the advancement of medical technology and medicine in general requires more flexibility and code capacity, current knowledge of the disease process, medical terminology and technologies need to reflected more effectively, ICD-9 cannot accommodate the need to compare costs and the coding needs to better support the interoperable data exchanged in the U.S.

Some of the ICD-10 coding changes have already been implemented in 2011 with a revision to ICD-9. Those changes include influenza related data, seizures brought on by post traumatic stress, cocaine and other drug induced stimulant poisoning, do not resuscitate status and homicidal ideation. For a complete and up to date list of the 2011 ICD-9 changes, visit www.cdc.gov/nchs/icd/icd9m.htm. The ICD-10 has been in use since 1994 for reporting morbidity and mortality statistics throughout the world and in the United States since 1999.

The ICD-10 coding changes will not affect the way the Doctor or other medical specialist documents the medical procedures, but will greatly affect the way the information is set into the ICD system. The ICD-10 coding changes will provide more specific and in depth information about the patient’s medical condition. The physician and hospital billing forms have already been updated to accommodate the coming changes.

Adopting the new changes and implementing the ICD-10 program will be costly. The change will require providers will incur costs to reprogram computers, retraining of coders and anyone who uses the codes, such as Doctor’s, and the productivity loss by those who use the codes. Union contracts will most likely have to be renegotiated to include retraining existing personal.

The overall costs to cover the changeover, as estimated by RAND Science and Technology Policy Institute, are estimated to be in the neighborhood of $425 million and $1.15 billion in onetime costs and between $5 million and $40 million a year in productivity loss.

The benefits of the ICD-10 coding changes will come from more accurate billing and hospital payments for new and improved procedures will range from $100 million to $1 billion. Fewer rejected claims that will result in an estimated $200 million to $2.5 billion in hospital fees. The implementation period will be between 2 and 3 years.

Please see the latest version of ICD-10 Coding on the World Health Organization’s web site.

Filed in: Medical Biller, Medical Biller Industry Job

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