Peer Reply Table: Cost Benefit Analysis

One area where access to care is a problem is in the rural communities. Healthcare professionals including physicians, nurse practitioners, and nurses all affect the quality and cost of care (Derksen, & Whelan, 2009). Going forward importance needs to be placed on using recourses more efficiently and effectively; these resources include but are not limited to tests, prescriptions,

Internal Processes * Qualify for a Patient Centered Medical Home (PCMH) * Communications – (entire staff) – with a quarterly staff meeting * Improve comfort levels with ICD-10 diagnosis coding

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.

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 Centers for Medicare and Medicaid Services (CMS) requires all providers to implement ICD-10 coding system begin on October 1st, 2015 so the U.S. healthcare system can communicate in the same language as with other countries’ systems. The transition from ICD-9 to ICD-10 had big changes from 14,000 diagnostic codes to more than 68,000 and 4,000 procedure codes to 87,000. The transition affected the reimbursements of hospitals. Medicare requires all patients’ procedures and services to be coded using ICD-10 system while they are charged in CDM using CPT codes. However, there is no direct link between ICD and CPT codes (Jensen, Ward, & Starbuck, 2016). The CDM committee had to work together to prepare for this event. Switching from numerical

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:

7. What are the hypotheses implicit or explicit in the statement of the problem and goals?

The difference between theses two medical coding systems that medical practices rely on being financial stability.ICD-9 contains approximately 13,000 codes and ICD-10 will contain a totally 68,000 available codes. The ICD-10 structure code is greatly expanded and the new codes are capable of reporting data in much greater specific. When the CMS mandated the changes to be effective in 2014. The data ICD-10 codes contain is expected to improve the efficiency of healthcare reimbursement and reduce charges of fraud and abuse. The ICD-10 billing will involve an all encompassing alphanumeric systemization. The ICD-10 diagnosis code will always be a letter then numbers. The ICD-10CM/PCS has two consisted parts, ICD-10-CM diagnosed classification system developed by the centers for disease control and prevention for use in all U.S. health care treatment settings. Diagnosis coding under this system uses 3-7 alpha and numeric digit and full code titles. ICD-9-cm is very much the same. ICD-10-PCS procedure classification system developed by the centers for Medicare and Medicaid services CMS for use in the U.S. for inpatient hospital setting only. The new procedure coding system uses 7 alpha or numerical digits while the ICD-9-cm coding system uses 3or4 numbers that's the

As necessary as ICD-10 is, smaller practices that only have a few physicians on staff will have more of a difficult time integrating the system than larger organizations. The reason being that larger healthcare organizations tend to have coders. Coders are individuals who hardly ever have contact with patients but they are important in the sense that they are the ones that input the ICD codes into patients’ medical records. Without coders, physicians would have to be the ones to input the ICD codes into the patients’ medical record. Luckily physicians at hospitals and other large health organizations do not need to do this. Unfortunately, physicians at smaller organizations do not have coders at their disposal and they are the ones that enter the ICD codes.

The topic of transitioning to the ICD-10 coding system has become a very big issue within the medical practice field. In fact, as of October 1, 2015, all physicians, hospitals, and medical providers are required by the federal government to be in full compliance using ICD-10 coding. ICD-10-CM codes allow for medical providers to provide as much information as possible about the patients state of health and all treatment provided as such. In addition, "The CPT coding system offers doctors across the country a uniform process for coding medical services that streamlines reporting and increases accuracy and efficiency (Ama-assnorg, 2015)."

Before discussing the implementation process of ICD-10 it is imperative to understand the differences between ICD-9 and ICD-10 coding and the reason for the transition. The new ICD-10 coding has over 69,000 codes to identify diagnoses compared to 14,000 in the ICD-9 coding version. The increasing number of codes will aid in specificity of all diagnoses. Every diagnosis has a specific code identity. The code identity for the ICD-10 coding is made up of seven digits whereas ICD-9 coding has only three to five digits for each diagnosis. These digits are numbers used to explain a specific injury or procedure. Behind each diagnostic code is an exclusion wording. It gives the diagnosis code in specific detail of the exact diagnosis the physician

It may surprise you to learn that the United States is the last country in the world with modern healthcare to adopt the latest ICD-10 code sets. Staying current isn’t the only reason our healthcare system is

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

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.