ICD-9-CM: A Case Study

"In the United States, ICD-10 has been used to classify mortality data since 1999, while we continue to use ICD-9-CM for all other purposes, such as billing and morbidity statistics. In addition, government agencies, health care insures, and providers are studying the implications of switching to ICD-10-CM." (Aalseth, 2006)

There are two trends that I have learned about from UMA and TV. ICD-10 replacing IDC-9. ICD-10 will provide the medical billing/coder with more descriptions for describing encounters and hospital stay for patients. Where ICD-9 had 3,824 procedure codes and 14,025 diagnosis codes, ICD-10 on the other hand, has 71,924 procedure codes and 69,823 diagnosis codes that is a big difference. The affordable care act also made an impacted on billing/coding since more people are getting procedures done. These procedures will need to be coded and documented for doctors and hospitals to get paid.

As you can imagine, ICD-10 codes allow for far greater specificity in clinical documentation. For example, the old ICD-9 system did not address laterality nor the episode of care. The old system also lacks other clinical specificities. For example, ICD-9 had one single code for a closed fracture of the femur (821.01) whereas ICD-10 will have at least 24 codes dealing with these kinds of

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.

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

Many people get confused when they hear the terms inpatient and outpatient. An inpatient is a patient hospitalized for more than 24 hours, but the stay can be less, depending on doctor’s orders. An outpatient is a patient that does not stay overnight in a medical facility and goes home. ICD-9-CM diagnosis codes are 3 to 5 digits long (numeric) or can be a letter followed by up to 4 digits (alphanumeric). For example, the code for Hypertension is (401.9), examination of the breast is (V76.10), and struck accidentally by a falling object is (E916). ICD-10-CM diagnosis codes are three to seven digits or characters long. The first character is a letter, and the second to seventh characters are letters or numbers. For example, sprain of unspecified

ICD-10 implementation will affect nearly all core operations of health care organizations. Numerous organizations use diagnosis codes for a variety of reasons. Transitioning to ICD-10 requires changes to almost all clinical and administrative processes and systems. These changes are required of all HIPAA covered entities. The workplace may be any type of healthcare organization, such as:

I do agree with you it will have a great dramatic impact in healthcare. If the coding system is not used in a proper way it can affect many system that uses codes. When using ICD-10 yes this will help to be more specific when it comes to coding. Its not going to be very easy but its is going to help and change the way the coding system is being used so there won't be No mistakes. Yes, there is a big different between ICD-9 and ICD-10-CM but it can be also easy to learn it because it the revision to all the codes. I do believe the change is good because it just going to help us use a specific code when diagnoses.

A number of countries have already moved to ICD-10-CM, but here in the United States we are still behind, and have not evolved from ICD-9-CM to ICD-10-CM.

Medical codes are used for various recording and reporting purposes within the medical industry. These codes can determine the diagnoses and treatments used in patient care, as well as the mortality and morbidity data that provide statistics. As time and technology progresses a strain has been amplified on coding systems used today that warrants a major update. The United States (US) has yet to implement the most current standardized set of medical codes that have been adopted by the rest of the developed world. This delay in part caused by Congress and the American Medical Association (AMA) is causing the American population to suffer in various ways. As implementation dates are being pushed back time and time again the field is increasing debt by lost opportunities and still not able to communicate medical data across US borders. The International Classification of Diseases , tenth revision (ICD10) can, with the help of the Affordable Care Act (ACA), reduce costs for medical treatment for patients and facilities as well as improve upon facility efficiencies and quality of care. Healthcare providers in the United States (US) should be mandated to implement current sets of International Classification of Diseases (ICD) without further delay to reclaim the forefront of medical care against the top-rated systems of other countries around the world.

ICD-10 is “The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States (Rouse, n.d.). ICD-10 replaced the hard to understand ICD-9. ICD-10 is now used to help prevent, fraudulent charges, wrongful coding, and it

The implementation of ICD-10-CM required advance preperation in health organizations. Staff needed to be trained on the changes and software had to be updated to accomadate the new system. There are several changes that should improve the coding process and therefore impact the coding professional. One major change is that all codes are alphanumeric which increases the number of codes that can be used. Another change is that the length of codes changed from five digits to seven characters. Also, some three-character categories have not been used. These three changes should allow for easier expansion in the future to avoid any more major revisions in the near future. The increased digits also allows for more specifity in the codes for

The ICD-10 system is not a perfect one. While it seems like a marked upgrade from the previous system in terms of accuracy and efficiency, it also can be excessively complicated and heavily affected insurance reimbursements, potential costing the patient more money.

In regards to the misconception that “the new ICD-10 codes are simply increased and renumbered code sets,” Medicaid.gov gives an overview of how the ICD-9 and ICD-10 codes differ and the far-reaching effects of the new codes. (Medicaid, n.d.) This overview discusses the expansion of the code set and the increase in the number of codes, but it goes on to relate other characteristics of the codes. The codes were in desperate need of change due to the dramatic changes in healthcare since ICD-9 was implemented over 25 years ago. The new code set provides for the consistency and modernization of medical terminology in the codes to reflect these dramatic changes. Although they seem more complex, the specificity of ICD-10 codes allows for more information to be conveyed using less codes when documenting a condition. Each code is not only a representation of a diagnosis, it also represents the associated symptoms, exact locations, and certain detailed information that is beneficial for future patient care and crucial for reimbursement and revenue processes. This is a definite improvement over the ICD-9 codes. (Medicaid, n.d.)

The installment of the ICD-10 coding into the United States healthcare system causes institutions to be faced with some difficult challenges. To conquer these challenges, the healthcare management team can establish an adequate planning strategy. The first strategy is to develop a management team. The management team can organize effective strategies in the work place to avoid costly mistakes. Education and communication are a few effective strategies an organization can achieve during the transition period. An article from the Healthcare Financial Management Association discusses that by not having adequate training for employees can lead to coding errors and reimbursement delays (Noel). By training employees on ICD-10 coding ahead of time