ICD-10 Medical Codes & ICD10 Code Software

Moving to ICD-10 CM/PCS will require a tremendous effort and incur incredible cost for health care organizations. Many medical organizations have not begun the implementation process and are expecting the date for implementation to be delayed. That is a misconception and could affect the health of the organization. The countdown is now. Don't delay planning for implementation. The health of your medical organization depends on it!

The Difference Effective Medical Software Makes

Medical organizations of all sizes require sophisticated software systems capable of managing more than 120,000 new ICD-10 codes in a way that allows simple, accurate look-up and application of codes in a busy clinical setting. Two-year support of both code types will further complicate this challenge. Additionally, the detail provided in medical encounter documentation needs to be more comprehensive to support this much-expanded diagnosis coding and utilize the new ICD-10 codes. That's where effective software gives your medical practice a major advantage.

AdvancedMD Medical Software Supports PCS & CM Code Sets

In the United States, the ICD-10 medical code set is technically comprised of two types: hospital procedure codes (ICD-10-PCS) and clinical modification diagnosis codes (ICD-10-CM). Regulations require a two-year transition period during which medical providers may have to submit either ICD-9 or ICD-10 codes to a specific payer as the industry migrates to this new medical code base. This adds another dimension of complexity that the billing software must be able to support. With AdvancedMD medical software, we’ve got you covered!

Comprehensive Medical Coding = Better Research, More Accurate Reimbursement

The impetus for the move to ICD-10 medical codes is founded in the inability of the current ICD-9-CM medical code base to support data essential in furthering medical research, outcomes management, and improved reimbursement systems. In a nutshell, the ICD-9 system has run out of assignable new medical codes. Because the classification is organized scientifically, each three-digit category can have only ten subcategories. Numbers in most categories have already been assigned to medical diagnoses. However, medical science keeps making new discoveries and there are no numbers left to assign to these new medical diagnoses, making it impossible to track and study them across large populations. [+]

Detailed ICD-10-CM diagnosis codes, combined with powerful software-based medical informatics, allow better analysis of disease patterns and treatment outcomes that can significantly advance medical care. These same medical code details streamline claims submissions, since these details make the initial medical claim much easier for payers to understand and categorize.

While much has been said about the increase in the number of ICD-10 medical codes, it should be noted that much of this growth is due to the designation of more lateral or specific diagnoses of related conditions. For example, while an ICD-9 code may simply identify a condition, such as a sprained ankle or foot (845.00), the new ICD-10 medical codes can identify the condition (sprain ankle S93.409) , as well as several specific ligament involvements, such as calcaneofibular S43.50, deltoid S93.42, and tibiofibular S93.43.

This specificity of the new ICD-10 medical code set, which will be supported in future releases of AdvancedMD medical software, enhances the ability of researchers to more precisely track conditions, treatments and outcomes, and for medical payers to more accurately identify related charges. ICD-10 codes also eliminate the confusion of having to combine medical codes under ICD-9-CM to describe a condition more accurately. For example, a single ICD-10-CM code can be found to report a disease and its current manifestation (i.e., type II diabetes with diabetic retinopathy) rather than having to use two separate ICD-9-CM medical codes. In fracture care, the new medical codes differentiate an encounter for an initial fracture; follow-up of fracture healing normally; follow-up with fracture in malunion or nonunion; or follow-up for late effects of a fracture. Likewise, the trimester is designated in obstetrical medical codes.

Facts, Timing & Impact of ICD-10 Medical Codes

Fact: ICD-10 replaces ICD-9 medical codes on October 1, 2013; this is an overhaul versus an update
Timing: There will be a transition period, prior to the October 1, 2013 go-live date, during which medical providers will have to submit either ICD-9 or ICD-10 codes, depending on the medical payers' readiness
Timing: Medical Practices will have to upgrade to the new 5010 electronic claims and transaction code requirements from the existing 4010 1A in order to accommodate the expansion in the ICD-10 codes; Health plans (large and small), medical health care clearinghouses, covered health care providers, and business associates are required to be compliant by January 1, 2012
Impact: The provider encounter documentation will have to expand in terms of diagnosis detail in order to support this new level of medical coding; this is expected to cause a huge impact on medical provider habits
Impact: Medical billing coders will have to be retrained, as there is no one-to-one relationship for many codes
Impact: Changes will impact medical coding operations, software systems, reporting, administration, registration and more

Expansion of ICD Medical Code Base

ICD-10 is a clinical diagnostic coding system first implemented by the World Health Organization (WHO) in 1993 and used in virtually every country in the world outside of the United States. It replaces the current 1970s-vintage ICD-9 medical code set which, due to limitations in its fundamental numbering schema, cannot accommodate the additional codes required to support rapidly-expanding medical research and disease management details.

ICD-10-CM medical codes expand the current ICD-9-CM code base by nearly nine times, from 13,600 codes to more than 120,000 new medical codes. Additionally, code structure increases in complexity, moving from predominantly numeric three to five digit ICD-9 codes to mixed alphanumeric ICD-10 codes that can contain up to seven digits. This increase in complexity and sheer number of medical codes requires automated code management features within medical practice management software and billing software in order to improve productivity and accuracy of medical coding professionals.

ICD-10 Impact on the Medical Practice

Productivity standards may have to be redefined, requiring more medical coding staff
Need to retrain existing staff and pay to send medical coders back to school
Medical providers have to change how they document, more detailed diagnosis information require
Each organization needs to develop an implementation plan

ICD-10 vs ICD-9

Comparison Table of ICD-9 & ICD-10 Diagnosis Medical Codes*

ICD-9-CM	ICD-10-CM
Approximately 13,600 codes	Approximately 120,000 codes
3-5 characters in length	3-7 characters in length
First digit may be alpha (E or V) or numeric; Digits 2-5 are numeric	First digit is alpha; Digits 2-5 are numeric; Digits 4-7 are alphanumeric
Limited space for adding new codes	Flexible for accommodating new codes
Lacks detail	Very specific
Difficult to analyze data due to non-specific codes	Specificity improves coding accuracy and data analysis for research
Does not support health data exchange with other countries	Supports health data exchange with other countries