ICD-10: Current and Future Implications

There was never any doubt that the healthcare industry would grow exponentially, but few people realized 15 or even 10 years ago how dramatic the changes were going to be. The American population has grown older at the same time medical technology has advanced. Treatments thought nearly impossible are now everyday occurrences. The demand for these new treatments combined with the growing number of elderly patients has placed its own unique strains on medical billing systems. These changes have resulted in the need for new a system of medical coding and it is the ICD – 10 codes that will be responding to the challenge.

The International Statistical Classification of Diseases and Related Health Problems, or ICD codes, are used to classify not only diseases but also a wide range of symptoms and procedures of healthcare. It is the basis for medical billing and the ICD – 9 has been the workhorse code for years. However, due to the advances in medical treatment and technology, not to mention legislative changes, there are more situations than the ICD – 9 codes can fully cover. The ICD – 10 code terminology has been in existence since the 1990s but was slow to be accepted by the healthcare industry in the United States. That is now about to change.

The United States Department of Health and Human Services is about to require that those healthcare entities that deal with the Health Insurance Portability and Accountability Act of 1996 (HIPPA) use the ICD – 10 in place of the older ICD – 9. There has been a recent delay announced of compliance until October 1, 2014 to allow for additional review, but unless something dramatic is uncovered it is likely that the ICD – 10 codes will be universally used in American healthcare. This will bring about a major change in the field of medical billing and records. The ICD – 10 code sets have over 150,000 different codes as opposed to the approximately 17,000 codes found in ICD – 9. The ICD – 10 takes into account the advances in medicine, treatment, and diagnosis that occurred in the past few decades. Moreover, the ICD – 10 has already been adopted by a number of countries, including Germany, France and Australia. It is most likely that more and more countries will adopt the ICD-10 codes in the coming years.

This new code will bring about sizable changes in how billing and recordkeeping are done. Career minded medical coders will have to become proficient in ICD – 10 code terminology and software, and medical billing and records keeping will have to be revised to reflect the ICD – 10 lexicon of terms and codes. This all may prove to be extremely expensive as the transition to the new codes runs its course. The possibility of some confusion and administrative difficulty is quite real, as this happens in the event of any major change. It does mean that institutions training medical coders will have to offer increasingly more courses in ICD – 10 and discard the ICD – 9 curriculums. Nevertheless, there is a sizable benefit to be derived from the new codes, including more precise labeling of treatments and symptoms among other things. The ICD – 10 codes will eventually make the pricing of various healthcare services easier and more accurate.

This article was provided by  Medical Coding Training & Certification Guide – a free resource for current and aspiring medical coders. From general industry information, to specific job opportunities, all the important aspects of the medical coding profession are covered.

ICD 10 and What it May Entail

Great article from MedCity News.

The US has been one of the first countries to adapt ICD 9 codes formedical billing and claims. With the industry focused on healthcare reform, changes in supporting functions are inevitable. The ICD 10 is far more comprehensive, featuring 68,000 documentation codes for diagnosis in comparison to the 14,000 of ICD 9. These codes could also include alpha numeric identifiers unlike ICD 9 and will span from 3-7 characters. Procedural codes for ICD 10 are expected to total about 87,000 and include 7 alphanumeric identifiers in comparison to 4,000 codes in ICD 9. The new codes are expected to be more compact in case classification, reducing chances of misrepresentation when dealing with insurance and medical billing companies.

Read the rest of the article.

AMA Updates Vaccine CPT Codes for 2012 – 2013 Use

As they have since 2006, the American Medical Association released updated CPT codes for vaccines last week ahead of the 2013 official code book release.

Some of the highlights of the semi-annual report:

  • Code 90653 – has been ACCEPTED for inclusion in the 2013 codebook production cycle
    “Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use”
  • Code 90739 – has been ACCEPTED for inclusion in the 2013 codebook production cycle
    “Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use”
  • Code 90672 – has been ACCEPTED for inclusion in the 2013 codebook production cycle
    “Influenza virus vaccine, quadrivalent, live, for intranasal use”
  • Codes 90685, 90686, 90687, 90688 were ACCEPTED for inclusion in the 2014codebook production cycle
  • Codes 90655, 90656, 90657, 90658, and 90660 will include the term trivalent, meaning “conferring immunity to three different pathogenic strains or species”

You can learn more about the changes for July 2012 at the AMA’s Category I Vaccine Code Page

Medicare is basis for medical billing errors

Cleveland.com; June 29, 2012

“In Sunday’s series on medical billing, Sarah Tribble and Dave Davis did a fantastic job unraveling the complexities health care providers endure in an attempt to receive payment for services. As the reporters duly note, in a system of such complexity, mistakes certainly happen. The mistakes we hear about most often arise when patients believe they have been overcharged for their care. This same system often results in providers being paid less than they should be for the very same reasons.” Full article