ICD-10

As part of the “Protecting Access to Medicare Act of 2014” bill, congress voted to delay the ICD-10 implementation date of 10/1/2014 to a date no earlier than 10/1/2015.

This will be one of the biggest, if not the biggest, transformations in U.S. health care.  Obamacare, Quality Reporting, CMS 2 day rule, Meaningful Use, HIE’s, NCTracks, ACO’s and Value Based Payments reform are all swirling around these days creating a frenetic environment in which to treat patients, but none will have a greater affect on revenue and reimbursement than being ready to submit ICD-10 codes next year.

What is ICD?

ICD (International Classification of Diseases) is a data system created by the World Health Organization (WHO) that is used to track social disease, morbidity, health trends, etc. The U.S. uses ICD codes as one reimbursement method, particularly for hospitals.

ICD codes touch or are part of a patient visit from the time they present with an illness until the final bill is paid.  It affects insurance verification, obtaining authorizations, patient estimates, physician orders to the hospital, all clinical diagnosis and treatment documentation needed from admission to discharge, IT systems, billing, claims, denials, audits, training, coding, paper encounter forms, reports, and ultimately the amount of reimbursement Johnston Health will receive from all sources.

Why Switch to ICD-10?

The migration from 16,000 ICD-9 codes (13,000 CM and 3,000 PCS) which were published in 1978 by the World Health Organization to 155,000 ICD-10 codes (68,000 CM and 87,000 PCS) published in 1994 touches all areas of health care.

Incomplete clinical documentation and choosing the wrong code has the potential to have more claims rejected, increased denials from payers, increased audits, delays in payments and most importantly could negatively impact the amount of reimbursement from the payers (all insurance companies, NC Medicaid, Medicare).

The goal of the new code set is to provide more complete documentation of both diagnosis and treatment and takes into account all the new technology and methods that have occurred since 1978. An example:

  • There are 4 ICD-9 codes for Sprained and Strained ankles.
  • There are 72 ICD-10 codes for Sprained or Strained ankles.