Written by Tuere Brannum
If you have ever paid attention to your hospital bills, patient files, etc. you would notice that there are a lot of codes involved. But what’s behind the codes? The codes are more important than you may think and there are a lot of rules associated with how these codes are categorized.
Hospitals, medical care facilities and those in this field use health care coding as a medical “universal” language. This way, the majority of affiliated health care relations can be on one accord with various processes and healthcare data. The health care industry has recently received information regarding an upgrade to the coding they have been using for quite some time now.
As of October 1, 2015, The United States’ Department of Health and Human Services (HHS) made an official announcement that the International Classification of Diseases, 9th edition, (ICD 9) will now be replaced with the ICD-10-CM/PCS code. ICD-9 has been used for medical coding for approximately 30 years to date and has been a reliable source of coding for the healthcare system.
Over this time period, there have been additions, modifications and many changes in US health classifications. As a result, ICD-9 has been determined to be incompatible and inconsistent. As the Centers for Disease Control (CDC) explains, the content of ICD-9 “is no longer clinically accurate and has limited data about patients’ medical conditions and hospital inpatient procedures, the number of available codes is limited, and the coding structure is too restrictive (CDC, 2013).”
In April 2014, U.S. Congress mandated a minimum delay for the ICD-10 release by approving the enactment of the Protecting Access to Medicare Act of 2014 (PAMA). Health care providers of all walks were anxiously awaiting the implementation of ICD-10. They took action such as spending/investing funds, revising plans and processes, improving policies, upgrading IT systems, as well as training and re-training employees in preparation of ICD-10. To those affected, the October 1, 2015 green light for ICD-10 was long overdue.
The health coding system known as, International Classification of Diseases, 10th Edition (IDC-10) was implemented for mortality coding and classification from death certificates, in the US in 1999 (CDC, 2013). Later, ICD-10-CM (clinical modification) was developed specifically for medical diagnoses. ICD-9-CM (volumes 1 and 2) was replaced by the new ICD-10-CM. After ICD-10-CM, an additional procedure coding system was developed for inpatient procedures, ICD-10-PCS. ICD-9-CM (volume 3) was replaced by the new ICD-10-PCS.
ICD-10 is what is up to date and is needed today in medical care processing. There has been an enormous improvement in the quality of data. In response to what many medical providers requested, ICD-10 codes capture the most recent advances in medical technology, external causes of injury, mental illnesses and primary care encounters. ICD-10 is a great enhancement over ICD-9 in that it includes details for chronic diseases, their causes and complications. ICD-10 includes alcohol level, blood type, the Glascow Coma scale and under dosing where ICD-9 does not. ICD-9 also omits descriptions of the severity and stages of different illnesses such as asthma, dementia and chronic renal problem, where ICD-10 will in fact, capture those details.
Since ICD-10 will be more detailed, it will allow for the most accurate information to be sent to Medicare and other patient care providers. When the patient history is as precise as possible, the physician can make a better informed decision on patient illnesses and treatments. Researchers and public health officials will now have a better account of a vast array of health care conditions and outcomes from diseases and epidemics to injuries and poisonings. In addition, due to the updated revision in health care descriptions, ICD-10 will aid in the improvement of health care payment processing, reimbursements, and inaccuracies.
Those who need to comply for the ICD-9 to ICD-10 transition include the following: clearing houses under the Health Insurance Portability and Accountability Act (HIPAA), electronic medical health record compliers (electronic transaction upgrades to Version 5015 standards will be necessary), Medicaid/Medicare claim submitters, medical providers, payers, insurances, billing services, employers and healthcare providers. ICD-10 is the improvement needed for support in the patient – health care system relationship and will deem to be an effective change.