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2 weeks ago
ICD-10 Information

Why did the U.S. change to ICD-10-CM and PCS?  How will ICD-10 affect future healthcare reimbursement?

      2 websites to reference:

      The National Center for Health Statistics website:   http://www.cdc.gov/hchs

            AHIMA:  www.ahima.org
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2 weeks ago
Found this excellent source!

Why is the United States changing from ICD-9-CM to ICD-10-CM?

There are numerous reasons that the United States needs to change from ICD-9-CM to the ICD-10-CM system. The current ICD-9-CM coding system lacks specificity and detail. If the reader has attempted data extraction utilizing the ICD-9-CM system, you have probably encountered difficulty obtaining the exact diagnosis for which you were searching. For many research purposes, the ICD-9-CM diagnosis codes can be very broad, and lack the specificity to narrow the search.

ICD-9-CM is running out of code capacity to expand and keep up with advances in technology. Most of the categories contained in ICD-9-CM are completely full with no room for expansion. Another reason for the switch is the growing need for precise quality data. As many of you are already aware, payment systems are requiring quality measure collection for all venues of healthcare.

It has become increasingly difficult to compare costs and outcomes of different procedures, treatments, and technologies. The ability to obtain access to very specific data is vital to the success of many treatments. Clinical trials require specific information on comorbid conditions, adverse events, and past medical, surgical, and social histories. Another reason to convert is the inability of ICD-9-CM to support the U.S. initiative to transition to a health data exchange.

By converting to the new ICD-10-CM system, we will expect to obtain better data for (1) measuring the quality, safety, and efficacy, (2) researching, and (3) gaining more efficiency in our healthcare system. The new ICD-10-CM system will allow for future expansion to accommodate the rapid introduction of new technologies into the healthcare system. In addition, we will finally be able to align the United States data with other ICD-10 coding systems worldwide. There is an anticipated reduction in coding errors due to the specificity of the codes, and an overall lowering of costs and improving efficiencies in the healthcare system.

Increased granularity in the diagnosis coding will allow for better medical necessity justification, accurate reimbursement, and easier monitoring of quality data for outcomes. The specificity of the new codes will allow researchers access to more specific data for their research purposes.

ICD-10-CM diagnosis codes will tell the story of each patient encounter, describe etiologies of the disease process, explain the complications of care, provide a basis for medical necessity, support coverage for payment purposes, identify incidence of disease, and support statistical tracking for healthcare practices, as well as provide disease state information on medical practices across the continuum of care. The new system's granularity will play an important role in determining the severity of the patient's condition and contribute to research on treatment outcomes.

In terms of reimbursement:

Increased granularity in the diagnosis coding will allow for better medical necessity justification, accurate reimbursement, and easier monitoring of quality data for outcomes. The specificity of the new codes will allow researchers access to more specific data for their research purposes.

Source 1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865615/
2) https://healthinformatics.uic.edu/blog/how-icd-10-has-impacted-healthcare/
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