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“Out with the Old and In with the New”- An exploration of the ICD-10 transition

Updated on May 2, 2014

A Season for Everything

October comes with many changes; leaves go from fresh green to warm reds and yellows and begin to fall to the ground. Students are falling into the everyday school routine and anyone covered by the “Health Insurance Portability Accountability Act” are switching their ICD-9 codes for ICD-10 codes. This last bit is not what an average citizen considers when thinking about the month of October but on October 1, healthcare providers (everyone covered by the aforementioned act, commonly called HIPPA) will begin to use ICD-10 codes when billing insurance companies.

The Differences between the Codes

This change seems relatively simple but there are many little nuances to the ICD-10 codes and to the transition itself that must be examined. To start off, ICD stands for International Classification of Diseases. This classification is used by health care providers and insurance companies. The coding system allows the two parties to have a mutual language by which to communicate the reason for a patient’s bill.

Another nuance of the coding system is that ICD codes only apply to inpatient procedures. All outpatient procedures are classified by CPT, Current Procedural Terminology, coding. It is important to note that the change regarding ICD codes will not affect the CPT coding system. The ICD coding system must be used by all entities covered by HIPPA including Medicaid.

Mark it on your Calendar

A key point regarding the ICD-10 coding transition is the timing. The actual transition deadline is Oct. 1, 2015 and this deadline is not very flexible. If ICD-10 codes are used prior to 10/1/15, then the claim will not be processed. On the other hand, after 10/1/15, ICD-9 codes cannot be used or as claims will not be processed as well but, providers have an understanding for difficulties while using ICD-10 coding up to 19 months after the compliance date.

A Frequently Asked Question Regarding the ICD-10 Transition

Since codes change every year, why is the change so special? The answer to this is that ICD-10 has a different form to their code. While ICD-9 is comprised of mostly three to five numeric digits, ICD-10 uses letters and numbers in a three to seven character code.

The Code

After exploring some gray areas of the ICD-10 transition, one can look at the actual codes themselves. It is interesting to note that one code is not used for all burns, or another used to convey a bill for all injuries needing stitches but rather one injury, for example an encounter with a corrosive substance , can have about six different codes. For example, code O T2056XA if defined as “Corrosion of first degree of cheek, initial encounter” while code, N T2056XS, is defined as “Corrosion of first degree of forehead and cheek, sequel”.

The similarities between just two of the six codes for just a corrosion of the first degree are almost uncanny. Needless to say that whoever’s job it is to implement and use every code in the ICD-10 coding system will need a strong cup of coffee in the morning.

Changes

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ICD-10

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