ICD-10-CM: A Case Study

The structural base for them are not quite the same. The setup for the manual, the formatting of codes and even some of the guidelines are different (not to mention ICD-10-CM has around 70,000 codes while ICD-9-CM has only about 16,000 codes).

Coding systems are used in the inpatient and outpatient settings for the classification of patient morbidity and mortality information for statistical use. The World Health Organization (WHO) developed the Ninth Revision, International Classification of Diseases (ICD-9) in the 1970s to track mortality statistics across the world. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), is the adaptation the U.S. health system uses as a standard list of six-character alphanumeric codes to describe diagnoses. Globally utilizing a standardized system improves consistency in recording symptoms and diagnoses for payer claims reimbursement, as well as clinical research, and tracking purposes.

The new system increases the number of procedure codes nearly 20-fold when compared with the old ICD-9 set. We’re talking going from about 4,000 procedure codes to 87,000 procedure codes.

The continue use of ICD-9 codes after the effective date could result in the denial of reimbursement claims. This task can be assigned to the healthcare organization’s management team to determine a solution avoiding a break down in the system. Rahmathulla states, “In instances of an audit, appropriate documentation will make the query process substantially easier while enabling coders to clarify issues without having to query the provider multiple times for answers” (“Migration To The ICD-10 Coding System S187). It is important to accurately document to reduce the amount of claim denials. With the new specificity requirement of the ICD-10 and documentation supporting a claim, lowers the chances of healthcare fraud. The healthcare management team will oversee the process to prevent the risk of exposure.

CMS preformed a comprehensive review of all diagnosis codes to determine which codes should be classified as CCs when present as a secondary diagnosis. CMS then categorized these diagnosis codes into the different severity levels. CMS also consolidated the CMS DRGs into a new set of base DRGs and then divided each into severity subclasses or MS-DRGs.

I am choosing ICD-10 Codes. The reason I have chosen ICD-10 codes is because every medical facility uses the ICD-10 codes for the billing and coding. That is the only way they get paid is by using ICD-10 codes. They will all receive adequate payments using the updated codes and the right type of billing.

ICD-10 is a huge change from ICD-9, the main purpose was to help coders code more specific. One benefit of ICD-10 is to give the doctor an electronic trail of proof for payments from patients, insurance, government, and hospitals. ICD-9 having diagnosis codes ranging from three to five digits but ICD-10 having diagnosis codes ranging from three to seven digits will automatically give you a more detailed code. Using ICD-10 gives you a lesser risk of getting audited. Giving a specific description on claim forms will make it harder to get the wrong code. ICD-10 will improve healthcare, the codes are more detailed making the data and communication flow faster. ICD-10's will help guarantee the physician reputation; the electronic trails are reported

The main and most obvious difference between ICD-9 and ICD-10 is that there is a significant increase in the amount of codes. ICD-9-CM has an approximate of 17,849 codes when combining all procedural and diagnosis codes, whereas ICD-10 has well over 68,000 Clinical Modification (CM) codes and over 71,000 Procedural Coding System (PCS) codes. There are also several structural differences between ICD-9-CM and ICD-10-CM/PCS. Some of them are:

- amount of procedure codes. ICD-10-CM has 71,924 codes compare to 3,824 codes in ICD-9-CM.

Suman De (2012) details the best practices for establishing ICD-9 and ICD-10 cross-maps in eight steps. First, all systems that utilize ICD-9 codes must be analyzed to identify the specific mapping requirements needed for continued support of those systems (De, 2012). Second, a core mapping team should be formed and consist of knowledgeable stakeholders from throughout the organization (De, 2012). Incorporating input across various departments will help verify that all business needs are met sufficiently. Third, and perhaps most critical, is to determine all ICD-9 codes that will require mapping to the ICD-10 set (De, 2012). This list should include the most commonly used codes in the organization, as well as those codes used in specific business functions. Each organization does not need to map the entirety of the ICD-9 code set; instead, only those codes that are relevant or important to the organization should be

ICD-10 – CM is a three- to seven character alphanumeric representation of a disease or condition. The first digit is alpha; Digit 2 is numeric. There is a decimal placed after the third character. There are 69,000 codes to better capture specificity, tis also

In 1978, the World Health Organization published ICD-9. It was later modified by the US Public Health Service so that it could service the needs of American hospitals. This modification was named International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM). As of October 1, 2015, ICD-9-CM was replaced with ICD-10-CM. ICD-10-CM was considered an upgrade from ICD-9-CM because it was more specific and contained many more codes than its predecessor. Most of the categories contained in ICD-9-CM were completely full with no room for expansion. ICD-10-CM goes into a lot more detail than ICD-9-CM. ICD-10 has been upgraded to contain up to seven digits as opposed to the four to five that were associated with ICD-9.

In 2009, the final rule required the adoption of ICD-10-CM codes. The implementation of the ICD-10-CM codes was to be established on October 1, 2013 by the Department of Health and Human Services. The ICD-10 will replace ICD-9, Volumes 1 and 2 and the process of transition from ICD-9 to ICD-10 will be very difficult, because ICD-10 contains nearly ten times as many codes as ICD-9 (Deborah Vines, 2013, pp. 132-140). The transition to ICD-10 is expected to improve the details of healthcare information and bring the United States in step with coding systems worldwide (Deborah Vines, 2013, pp. 132-140). The ICD-10 will have a solid impact in the healthcare industry, it will result in advance coding accuracy and specificity, more accurate information for measuring healthcare service quality, safety, and efficiency, lower costs, enhance the ability to track and respond to public health threats, and enhance ability to meet HIPAA electronic transaction/code set requirements. It will consist of two conversion tools Mapping and crosswalks to assist with the transition. Crosswalks provide a direct match, a one-to-one relationship between ICD-9 and ICD-10 but crosswalk does not take into consideration the complexity of ICD-10 (Deborah Vines, 2013, pp. 132-140). Mapping reflects the complexity of the codes sets rather than the oversimplifying (Deborah Vines, 2013, pp.

The compliance date for implementation of the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) was October 1, 2013 for all covered entities. Although, a number of countries that have already converted to ICD-10:

ICD-10, which is the tenth revision of the International Statistical Classification of Diseases and Related Health Problem, refers to a medical classification inventory for the coding of diseases, their signs, symptoms and causes (Center for Disease Control and Prevention 1). The use of this revised version in the United States is scheduled to begin officially on the first of October 2013. Currently, ICD-10 is being used for diagnosis coding, in procedure coding systems and for inpatient procedure coding.