Preparing for the ICD-10 Transition

As the October 1, 2015 deadline quickly approaches, health care providers, payers, clearinghouses, and billing services are in the final stages of transitioning from ICD-9 to ICD-10.  ICD is the abbreviated term for “International Classification of Diseases” and 10 representing the tenth revision. ICD Codes identify the diagnosis on the billing; ICD-9 codes uses 3 to 5 numeric digits and ICD -10 coding will use 3 to 7 digits and will report diagnoses in all clinical settings.

With the numeric coding changes comes the expansion of the current 14,000 available diagnosis codes to more than 67,000 and procedure codes from 13,000 to 85,000.  This highly complex system will provide a level of detail to claims processing that is complete, accurate, up to date and intended to save claim costs on improperly coded submissions. Eventually the transition implementation cost to health care providers, payers, clearinghouses and billing services will be translated back to consumers.

Widely accepted and used in the United States, the ICD-9 coding structure has limited the ability to properly identify the diagnosis trends, public health needs, epidemic outbreaks, and bioterrorism events.  Because of the ability to classify diseases and related health problems over 25 countries are currently using ICD-10.

The US belongs to the World Health Organization which requires notification of all events that constitute a public health emergency of international concern. Adoption of ICD-10 facilitates detection, verification and appropriate responses to epidemic-prone and emerging disease threats, comparisons of quality of care and sharing of best practices on a global level.

To meet the Health Insurance Portability and Accountability Act (HIPAA) requirements a code set had to, meet the needs of the health data standards user community and be consistent and uniform with other HIPAA standards.  ICD-10 meets the standards that will enhance accurate payment for services rendered, improve quality of care and documentation, and will identify diagnoses and procedures precisely, including the ability to accurately compare data worldwide.  All services rendered on or after October 1, 2015 must be coded using ICD-10, services on or after October 1, 2015 with ICD-9 will be considered as non- compliant transactions.

Transition to ICD-10 codes will provide fewer rejected claims, improved benchmarking data, including identifying abusive or fraudulent reimbursement submissions, and providing consumers with data on cost and outcome of treatment options. The final intent is to enhance business due to lower cost in premiums, and increase customer confidence from the improved development of strategies to prevent illness and injuries.

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About David Burjoski

As the Director of Communications for J.W. Terrill, David is responsible for all aspects of marketing, advertising, public relations, social media, and branding.

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