ICD-9 Codes: A Case Study

In the health care system, there are a lot of codes that help diagnose, treat, and discharge patients daily. Codes help nurses

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.

Read the article Diagnosis Coding and Medical Necessity: Rules and Reimbursement by Janis Cogley located on the AHIMA Body of Knowledge (BOK) at http://www.ahima.org.

As I type these words there are only 20 days until October 1st, AKA, ICD-10 transition day. Most people in the healthcare industry are wondering what that day will be like. What will happen? What will they have to do?

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.

21 DIAGNOSIS OR NATURE OF THE ILLNESS OR INJURY - Enter the applicable ICD indicator to identify which version of ICD codes is being reported. Enter the indicator between the vertical, dotted lines in the upper right-hand portion of the field.

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.

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.

We as Coders and Billers should understand the interaction of the CPT procedural codes and the ICD diagnostic codes. The providers receive payment for their service, whether it is an office visit or an operation in the hospital. All services need to be coded for proper payment.

1. A 54-year-old patient is seen by the physician in the outpatient clinic setting for CLL that is currently in remission. The patient's WBC counts, particularly lymphocytes remain within normal limits

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:

One of the greatest milestones in the United States health system is the use of electronic health records codes to ensure consistency in diagnosis and treatment procedures provided by physicians (Romano & Stafford 2011). The purpose of the case scenario of the sixteen year old female who visits the emergency department is to show how electronic health record coding is done and its impact on health reimbursement. The International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) codes are brought out well in the case study showing how they help in ensuring physician consistency in coding diagnosis and treatment procedures for the purpose of health reimbursement.

An accurate and specific documentation of universally accepted set of codes are important for the protection of healthcare providers as well as increased reimbursement for services received. These codes are for the validation of which services the patient received from their health care provider ( (Page, 2009). Having the correct codes in place insures the provider with the information needed by the health insurance carrier. Maintained by the AMA (American Medical Association), this universal numeric assignment is also used for developing guidelines for medical care review as well as data collection for medical education and research (Scott, 2013).

The majority of the time the use of HIM coders are involved in billing and reimbursements. However, coding specialists are important players within the healthcare industry.(Davis, 2014,2007,2002) They certify that providers maintain accuracy with coding procedures and government rules. (Davis, 2014,2007,2002) HIM functions and complex of regulatory requirements where coding can be very challenging. (AHIMA, 2016) The coders follow guidelines of the American Health Information Management Association AHIMA) Code of Ethics. (AHIMA, 2016) On the patient level, it is vitally important for the coder to code accurately because this information will trail the patient success throughout their course of treatment and beyond.

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.