ICD-9 to ICD-10 Transition – Why is this HUGE?

by Priya Menon

Currently, the U.S. health care system relies on a set of codes, referred to as ICD-9 codes. These codes are used in reporting diagnoses, in patient procedures in medical facilities.

The government mandates that ICD-9 be replaced with the more detailed ICD-10, and the deadline for transition ends on October 1, 2015.

Transition is mandatory for anyone covered by the HIPAA(Health Insurance Portability Accountability Act), which means that all hospitals, health insurance companies, doctors and everyone else relying on these codes for diagnosis or billing for services will be covered.

What is ICD-10 ?

ICD stands for the International Classification of Diseases, and its codes hold critical information about epidemiology, managing health, and treating conditions.

ICD codes are used by:

  • Healthcare professionals to record and identify health conditions.
  • Public health workers to observe trends in health and track mortality.
  • Insurers to classify conditions and determine reimbursement.

Why is ICD-9 to ICD-10 transition important?

ICD-9 code set is about 30 years old. It is far behind in mirroring the way medicine is practiced now and will be in the future.

Transition from ICD-9 to ICD-10 is huge since ICD-10 comes with a five-fold increase in diagnosis codes to about 69,000 codes. While ICD-9 includes 13,800 three-to-five-digits, primarily numeric codes, the ICD-10 codes contain five times the number of three-to-seven-digit alphanumeric codes. The expanded codes incorporate far more medical detail that ICD-9 codes did. Moreover, ICD-10 has combination codes. This makes it possible to code multiple diagnoses in one code.

ICD-10 allows capture of data regarding risk factors, symptoms, comorbidities and thereby provides more details of overall clinical issue. This will also enable the United States to participate in exchange of information across international borders.

What happens if you do not switch to ICD-10?

If an insurance payer or medical practice is not ICD-10 compliant by October 1, 2015, claims may not be processed.

Note: The transition does not affect any change to the CPT codes (American Medical Association’s Current Procedural Terminology) used in outpatient procedures.

Advantages of ICD-10 Code Transition

Advancement of health care is the main agenda for this code transition. Some of the advantages include:

  • Improved accuracy of diagnoses codes
  • Updated disease classifications and medical terminologies
  • Efficient payments with minimum errors
  • Availability of more detailed data for analysis and study of disease patterns
  • Improved efficiency of health care industry

Interestingly, MedData is tweeting ‘every billable ICD-10 code (not necessarily in order)’ providing a glimpse of the vastness of the diagnostic coding library.

 

The archive would certainly prove useful for physicians find the right code post October 1st.

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