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Icd 10

The document discusses the transition from ICD-9 to ICD-10 diagnosis and procedure coding systems mandated by HHS for implementation on October 1, 2013. ICD-10 will provide more specific coding, such as differentiating between left and right sides of the body. It will expand the number of available codes from around 15,000 to over 155,000. The increased specificity of ICD-10 codes will improve reimbursement processes, data analysis, and public health tracking. However, the transition requires medical professionals to improve documentation and for coders to learn more anatomy.

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Radhika Shah
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400 views4 pages

Icd 10

The document discusses the transition from ICD-9 to ICD-10 diagnosis and procedure coding systems mandated by HHS for implementation on October 1, 2013. ICD-10 will provide more specific coding, such as differentiating between left and right sides of the body. It will expand the number of available codes from around 15,000 to over 155,000. The increased specificity of ICD-10 codes will improve reimbursement processes, data analysis, and public health tracking. However, the transition requires medical professionals to improve documentation and for coders to learn more anatomy.

Uploaded by

Radhika Shah
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Medisoft ICD 10 Implementation and Deadlines

Medisoft ICD 10 Info

What is Medisoft ICD-10?:


ICD 10 is the new diagnosis classification system 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

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

Date of service for ambulatory and physician reporting: Ambulatory and physician services provided on or after October 1, 2013 will use ICD-10-CM diagnosis codes Date of discharge for hospital claims for inpatient settings: Inpatient discharges occurring on or after October 1, 2013 will use ICD-10-CM and ICD-10-PCS codes ICD-9-CM codes will not be accepted for services provided on or after October 1, 2013 ICD-10 codes will not be accepted for services prior to October 1, 2013

What is the Difference Between ICD-9 vs. ICD10?


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.

Why do we need to change at all from ICD-9 to ICD-10?


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

Can you show me an example of what a ICD 10 code looks like?


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. For most physician practices, GEMs will be of limited use and may not be appropriate since coding should occur directly to ICD-10 based on actual clinical documentation, rather than a mapping from existing ICD-9 codes. In some instances, GEMs can be helpful in validating your coding practices to help identify some codes in ICD-10 relative to existing ICD-9 for the purpose of training and validation. The ICD-10 codes will be increasing from approximately 15,000 ICD-9 codes to 150,000 ICD-10 codes, although coders will not need to know every code. GEMs can be compared to a phone book coders will not use every number, but it is nice to know they are all there. Visit the CMS website at http://www.cms.gov/ICD10 for more information on GEMs.

Is ICD-10 substantially different from ICD-9?


There is a lot of formatting and structure that is different in ICD-10-CM than it is in ICD-9. Because of the higher level of specificity, for those coders that dont have a strong understanding of anatomy and pathophysiology, they might need a refresher on some courses that will help bring them up to speed with a higher level of specificity thats found in the new code set. And keep in mind that they are also going to have to code into dual systems, for some perio

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