ICD-11 Transition Report

There are two trends that I have learned about from UMA and TV. ICD-10 replacing IDC-9. ICD-10 will provide the medical billing/coder with more descriptions for describing encounters and hospital stay for patients. Where ICD-9 had 3,824 procedure codes and 14,025 diagnosis codes, ICD-10 on the other hand, has 71,924 procedure codes and 69,823 diagnosis codes that is a big difference. The affordable care act also made an impacted on billing/coding since more people are getting procedures done. These procedures will need to be coded and documented for doctors and hospitals to get paid.

The main and most obvious difference between ICD-9 and ICD-10 is that there is a significant increase in the amount of codes. ICD-9-CM has an approximate of 17,849 codes when combining all procedural and diagnosis codes, whereas ICD-10 has well over 68,000 Clinical Modification (CM) codes and over 71,000 Procedural Coding System (PCS) codes. There are also several structural differences between ICD-9-CM and ICD-10-CM/PCS. Some of them are:

The United States implemented the current version (ICD-9) in 1979. ICD-10- CM is the mandated code set for diagnoses under the HIPAA Electronic Health Care Transactions and Code Sets standard starting on October 1, 2014. While most countries moved to ICD-10 several years ago, the United States is just now transitioning into ICD-10 and has to be compliant by October 1, 2015. ICD has been revised a number of times since the coding system was first developed more than a hundred years ago.

- amount of diagnosis codes. ICD-10-CM has 69,823 codes compare to 14,025 codes in ICD-9-CM.

Are you and your staff anywhere near ready for ICD-10’s October 1st deadline? Maybe you’ve been overwhelmed just trying to implement all of the other changes happening in healthcare thanks to the Affordable Care Act, EMR mandates, increased Medicare audits, and value-based purchasing penalties; you’ve hardly had time to prepare for this latest coding switch.

The continue use of ICD-9 codes after the effective date could result in the denial of reimbursement claims. This task can be assigned to the healthcare organization’s management team to determine a solution avoiding a break down in the system. Rahmathulla states, “In instances of an audit, appropriate documentation will make the query process substantially easier while enabling coders to clarify issues without having to query the provider multiple times for answers” (“Migration To The ICD-10 Coding System S187). It is important to accurately document to reduce the amount of claim denials. With the new specificity requirement of the ICD-10 and documentation supporting a claim, lowers the chances of healthcare fraud. The healthcare management team will oversee the process to prevent the risk of exposure.

RE: Unit 3 7/27/2015 5:05:08 PM I'm with you Jerica. ICD-9 seems like a cakewalk compared to ICD-10. I think the more work we do the better we will get. CPT coding has been the easiest by far.

As I type these words there are only 20 days until October 1st, AKA, ICD-10 transition day. Most people in the healthcare industry are wondering what that day will be like. What will happen? What will they have to do?

Physicians and other facilities are paid by insurance companies, including Medicare and Medicaid, based on the procedure (CPT) code they submit. These codes must be accompanied by the correct diagnosis or ICD-10 codes.There must be a valid reason for a medical encounter for the physician to be paid, such as pain, refills for medications, or a follow-up for such diseases as diabetes or any chronic condition. If you just submit the CPT or ICD-10 code separately then you will not be paid as both support each other. So it is vital that a medical biller and coder be aware of these rules and how to complete the claim forms properly.

This article discusses how the implementation of the new ICD10 codes are costing more than originally planned. All practices are required to use 2014-certified electronic health-record technology in order to receive funding from a federal electronic health record incentive program. The new estimates for the ICD10 implantation include the cost of such things as education, IT and documentation

where icd-9 codes are presently being used. That will make sure that no one is left

A number of countries have already moved to ICD-10-CM, but here in the United States we are still behind, and have not evolved from ICD-9-CM to ICD-10-CM.

I think transitioning over to ICD-10-CM will make coding easier by being more specific with the descriptions. I think that the biggest challenge is going to be just learning the different sections of the ICD-10-CM. Some other challenges may include training in ICD-10-CM, the cost of the transition, and maintaining two coding systems because some private insurance like workman compensation insurance are not required to switch over to ICD-10-CM. I believe that we have had ICD-9 since 1979 with updates yearly, which makes the ICD-9 over twenty years and almost thirty years old. A lot has changed in the medical world since then and we are due for a change. Anything new will take some time to learn and I believe that the transition would be

Another interesting perspective comes from the Heritage Foundation in an article titled: The New Disease Classification (ICD-10): Doctors and Patients Will Pay. It was presented for review on May 18th, 2015, and was authored by: John Grimsley, and John S. O’Shea.

Imagine you are laying in a hospital bed connected to multiple machines, IV’s and monitors. The only thing keeping you alive is the heart and lung machine, the team of doctors, nurses and specialist. Even with the help of modern medicine you will only remain alive as long as you stay in that hospital bed; attached to those lifesaving machines. Even with the help of those machines your life is not guaranteed. Now imagine knowing that the only thing that can save your life is a heart transplant, and having to wait your turn on a very long list to get one.