The ICD10 can be seen as a simple update to the older ICD 9. In reality, however, it is far more than that. It is a whole new set of codes, which have been designed to allow far more specific details to be included about medical conditions and procedures. Because of the specific nature of ICD 10 codes, the medical insurance and the healthcare industry can benefit significantly. So what are these benefits?
Benefits From ICD 10 Codes:
1. The quality of clinical documentation is improved. It relies on clinical documentation and with it thousands of procedure and diagnostic codes have been created specifically for the new system. These codes allow for precision in the clinical documents.
2. The quality of healthcare improves. ICD-9 was designed to streamline the reimbursement process. ICD 10 codes, by contrast, are based on performance rather than returns. This means that healthcare quality should improve as well.
3. They can prevent fraudulent activities in the industry. According to the NHCAA (National Healthcare Anti-Fraud Association), between $70 billion and $234 billion per year are lost on healthcare frauds. It is becoming increasingly common for codes to be manipulated for insurance purposes by various healthcare settings. The ICD-9 was much too generic, which made it easy to do this, either on purpose or through human error. The ICD-10 is much more specific, making it harder to manipulate. Over time, this should lead to a reduction in fraudulent activities.
4. They have better reporting features. The ICD 10 codes are used not just for billing, but also for research and surveillance of health. Furthermore, they will provide details on the various health issues that people have. For instance, the ICD-9 only had a code for “brain tumor”. The ICD-10 has one that shows which hemisphere is affected and whether it is the first tumor or a recurrence.
5. They offer interoperability. The ICD-9 made it very difficult for the US to share information on healthcare with other countries, because the ICD 10 codes were already implemented in most other countries. This means that our country has finally been able to bridge the gap and this makes it easier to share information across borders. This should lead to quality of care being more efficient and empowered.
6. They are far more accurate, fewer codes are needed. There are some 150,000 codes associated with the ICD 10, which are far more than with the ICD 9. However, because these codes are so specific, only one is needed at a time. With the ICD 9, numerous codes were often required for each procedure.
The Do’s and Don’ts:
As a medical coder, it is important that you know what you are doing with the ICD 10 codes. While they have been implemented for a while now, and international coders have many years of experience with the codes, some still find them quite difficult to manage. This is possible because the ICD 10 represents change, and change is often difficult to manage. It is hugely important, therefore, to be aware of the specific do’s and don’ts as they relate to this system.
Hence, the following are what should not be done with regards to ICD 10 codes:
– Procrastinate and think it can wait. The official implementation date of the ICD 10 codes was October 1, 2013, yet many healthcare organizations are still lagging behind and still relying on the ICD-9, simply because that is what they were used to. If you are one of those agencies, or if you work as a coder and spot a healthcare clinic that still uses the old codes, it is time to take action. The implementation of the ICD-10 was properly planned for and should now have been completely resolved. By making sure you are on track with national implementation, any issues that have arisen as a result have been resolved for you as and when they happen.
– Assume the coders will be able to do everything. The ICD-10 is highly complex and this means the entire healthcare team has to work together to properly implement it. Coders have to continue to work with ICD-9, while at the same time learning about ICD-10. They should not be solely responsible for the implementation, therefore. Similarly, physicians who list an ICD-9 code, presuming that the coding team will be able to translate it into an ICD-100 code are not helping the issue. The implementation has to be a team effort, in which the billing team, the IT team, the transition management team, and everybody else has to work together.
The important do’s for the ICD 10 codes, meanwhile, are:
– Make sure the coding team has been properly trained on the new codes. Comprehensive sessions have to be made available for coders so that they can understand the new system. These teach them about the new codes and also provide them with case studies and real life examples of the different medical terminologies that they may now include. These sessions have been designed to improve logical thinking in relation to medical billing and coding. They also ensure that, as soon as coders begin using ICD-10, they can do so properly and independently. Additionally, this means that they will complete the new ‘Anatomy and Pathophysiology’ modules, which are essential for anyone working with the ICD-10. Overall, this means that they keep their knowledge up to date and relevant.
– Make sure you have the right technology in place. There are now a lot of new IT tools available that help with the implementation and understanding of ICD-10 across the board. It is very important that you pick the right one for your setting, which is not necessarily the first one you come across, nor does it have to be the cheapest one.
– Stay up to date with developments regarding the ICD 10 codes. Throughout its implementation, ICD has offered lots of tools and resources to help healthcare settings make the switch. Additionally, it is regularly updated in conjunction with Medicare, and it is important that all coders and healthcare specialists are aware of these updates and changes. All practices should commit to regularly check for new updates to the system as a whole.
– Make sure your clients are aware of the switch, which is common courtesy.