What is ICD-10?
ICD-10 is the classification system currently being used by the majority of the world. The US is the only industrialized nation not using an ICD-10-based classification system. The ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets.
ICD-10 consists of two parts:
1. ICD-10-CM diagnosis coding
2. ICD-10-PCS inpatient procedure coding
ICD-10 diagnosis coding is for use in all US healthcare settings. Diagnosis coding uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9, but the format of the code sets is similar.
ICD-10 inpatient procedure coding is for use in U.S. inpatient hospital settings only. ICD-10 procedure coding uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9 procedure coding. The procedure coding is much more specific and substantially different from ICD-9 procedure coding.
The transition to ICD-10 is occurring because ICD-9 produces limited data about patients' medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.
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What is the value of ICD-10?
- Higher quality information for measuring healthcare service quality, safety and security
- Greater coding accuracy and specificity
- Improved efficiencies and lower costs
- Reduced coding errors
- Alignment of the US with coding systems worldwide
What is changing with ICD-10?
ICD-10 is not an update to an existing code set; it is a whole new code set. As
of the latest version, there are 68,000 existing codes, as opposed to the 13,000 in ICD-9. Here is how they compare:
Why is the switch to ICD-10 happening?
The healthcare industry is making the transition from ICD-9 to ICD-10 because:
- ICD-9 codes provide limited data about patients' medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, it has outdated and obsolete terms and is inconsistent with current medical practices. Also, the structure of ICD-9 limits the number of new codes that can be created, and many categiories are full.
- ICD-10 codes allow for greater specificity and exactness in describing a patient's diagnosis in classifying inpatient procedures. ICD-10 will also accommodate newly developed diagnoses and procedures, innovations in technology and treatment, performance-based payment systems and more accurate billing. ICD-10 coding will make the billing process more streamlined and efficient, and this will also allow for more precise methods of detecting fraud.
Impacts of ICD-10
As this transition will affect our entire national healthcare system, ICD-10 will affect in various degrees everyone who works in the healthcare industry. It will also affect nearly every business process and system within our organization, including Pender Memorial Hospital, NHRMC Physician Groups and NHRMC Home Care. Operational impact
will vary among hospital areas and departments according to campaign phase as outlined in the chart below:
||Physicians/PAs, Coders, CDI Specialists, Home Health Practitioners
||MD Practice Staff, Patient Access, Schedulers, Professional, Home Health and Hospital Billers, Report Writer/Data Analysts
||Reimbursement, Compliance, Ancillary technicians
||Nursing, Senior Management, IT
Of concern to all who work and care for patients at NHRMC should be ICD-10's financial impact. This is not to be underestimated. For reimbursement to occur in a timely manner, diagnosis and procedure codes must be accurately coded. Errors or mistakes in this process - from physician documentation to the actual inputting of codes - could substantially slow the reimbursement process or, at worst, result in no reimbursement at all.
NHRMC's ICD-10 Implementation Plan
Compared to other healthcare organizations across the nation, NHRMC is already well ahead of the curve in terms of preparing for the ICD-10 code transition. An executive steering committee was formed many months ago to begin initial preparation discussions, in addition to a governance model, and work groups with very specific tasks have resulted.
NHMRC's ICD-10 implementation will occur in the following three distinct, but related and overlapping phases: Awareness, Education & Training and Go-live.