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Why ICD-10?

As healthcare professionals know, physicians, coders, billers to name a few that ICD-9-CM is on the way out, and ICD-10/ICD-10-PCS is waiting for the curtain to go up on October 1, 2014. What is it…why are we changing…what will it mean to the profession? These are just a few questions on everyone’s mind.

The new system, ICD-10, is a classification system developed by the National Center for Health Statistics (NCHS) as a clinical modification to the ICD-10 system developed by the World Health Organization (WHO) primarily as a unique system for use in the United States for morbidity and mortality reporting.
Interesting to note: ICD-10 was adopted for use in the coding and classification of mortality data on death certificates as early as January 1, 1999.

ICD-10 is the copyrighted product of the World Health Organization, who has authorized the development of a clinical modification ICD-10 for use in the United States. All modifications must conform to WHO conventions.

Highlights of ICD-10 include:
Information relevant to ambulatory and managed care encounters.
Expanded injury codes.
Creation of combination diagnosis/symptom codes to reduce the number of codes needed to fully describe a condition.
Incorporation of common 4th and 5th digit sub-classifications.
Classifications become specific to laterality.
Classification refinement for increased data granularity.

What this means in practical terms

There will be new, more intensive demands put on healthcare providers.

Clear, more concise documentation will be required; if something is not clearly documented, it cannot be coded.
Documentation will drive an increased level of specificity.
Specificity will drive revenue and denials.
Medical necessity will also be monitored closely by the new coding system.
Increased specificity will lead to an increased level of care.
New demands for specificity leads to more focused documentation.
There will be an increased focus on physician documentation.
Clinical information will be at a premium under ICD-10.
Laterality will become a coding issue.
Combination codes will be more prolific and will be wider in scope.

Differences between ICD9 and ICD-10
ICD9 has approximately 14,000 codes.
ICD-10 has approximately 70,000 codes.

ICD9 codes are mainly numeric.
ICD-10 codes are alpha-numeric.

ICD9 codes have a maximum of 5 digits.
ICD-10 codes have a maximum of 7 digits.

It would be wise and expeditious to start your understanding of this new coding system without delay. Procrastination will prove dangerous. October 1, 2014 will be here before you know it.
Will you be ready for ICD-10?

For additional information, please feel free to contact me at Castlerock Management Corp. We can provide in service classes and reference information.

Claude J. Garbarino, CCS
Director of Medical Coding
Castlerock Management Corporation
CGarbarino@CastlerockManagement.com
(973) 625-3366