What is ICD-10?
ICD-10-CM is the International Classification of Diseases, 10th Revision - Clinical Modification. On October 1, 2015 it will replace ICD-9-CM as the coding classification system required by CMS and HIPAA Transactions and Code Set Regulations for billing and clinical quality reporting.
ICD-9-CM was written in 1977. Since then, healthcare knowledge and technology have greatly advanced and ICD-9-CM can no longer support the specificity to describe these advancements being limited to only two digits after the decimal point.
ICD-10-CM was designed with the idea that healthcare delivery and technology are not static, but constantly changing. It has far greater granularity, specificity, and more current clinical data. Also, the language has changed to reflect more site-specific and common disease names.
ICD-10-PCS is the International Classification of Diseases, 10th Revision - Procedure Classification System. This is a part of the ICD-10 requirement that applies to inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding. CPT will continue to be used for Provider Billing and Outpatient Facility billing.
Who will be impacted?
Coders and Clinical Documentation Improvement Specialists will be most impacted by the transition since they will need to undergo comprehensive re-training on the new coding systems to be able to continue to perform their jobs. An estimated 60 to 150 hours of training is needed.
Physicians will need to understand the impact of clinical documentation on code assignment and must adjust their practices to more completely describe the patient’s conditions. In addition, physicians will need to learn to utilize upgraded information systems and new applications to provide specific diagnoses and codes in their notes for Professional Billing.
Billing staff will feel the impact through information system upgrades. Thorough testing of the billing process both internally and externally will be required. Also, there is huge potential for slowdown in cash flow and increased denial rates depending on payer readiness.
Other staff will need to understand the significance of the transition to either shore up medical record documentation, monitor or report on clinical outcomes, and track financial trends.
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