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  • In the United States, the ICD-10 medical code set is technically comprised of two types: hospital procedure codes (ICD-10-PCS) and clinical modification diagnosis codes (ICD-10-CM). Regulations require a two-year transition period during which medical providers may have to submit either ICD-9 or ICD-10 codes to a specific payer as the industry migrates to this new medical code base.

Comprehensive Medical Coding = Better Research, More Accurate Reimbursement

  • The impetus for the move to ICD-10 medical codes is founded in the inability of the current ICD-9-CM medical code base to support data essential in furthering medical research, outcomes management, and improved reimbursement systems. In a nutshell, the ICD-9 system has run out of assignable new medical codes. Because the classification is organized scientifically, each three-digit category can have only ten subcategories. Numbers in most categories have already been assigned to medical diagnoses. However, medical science keeps making new discoveries and there are no numbers left to assign to these new medical diagnoses, making it impossible to track and study them across large populations.

Detailed ICD-10-CM diagnosis codes, combined with powerful software-based medical informatics, allow better analysis of disease patterns and treatment outcomes that can significantly advance medical care. These same medical code details streamline claims submissions, since these details make the initial medical claim much easier for payers to understand and categorize.

While much has been said about the increase in the number of ICD-10 medical codes, it should be noted that much of this growth is due to the designation of more lateral or specific diagnoses of related conditions. For example, while an ICD-9 code may simply identify a condition, such as a sprained ankle or foot (845.00), the new ICD-10 medical codes can identify the condition (sprain ankle S93.409) , as well as several specific ligament involvements, such as calcaneofibular S43.50, deltoid S93.42, and tibiofibular S93.43.

Facts, Timing & Impact of ICD-10 Medical Codes

  • Fact: ICD-10 replaces ICD-9 medical codes on October 1, 2014; this is an overhaul versus an update

  • Timing: There will be a transition period, prior to the October 1, 2014 go-live date, during which medical providers will have to submit either ICD-9 or ICD-10 codes, depending on the insurance payers' readiness

  •  Impact: The provider encounter documentation will have to expand in terms of diagnosis detail in order to support this new level of medical coding; this is expected to cause a huge impact on medical provider habits

  • Impact: Ware Langhorne & Associates’ certified procedural coders will retrain providers, as there is no one-to-one relationship for many codes

  • Impact: Changes will impact REVENUE, medical coding operations, billing software, reporting, administration, patient registration and more

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