Uncovering Healthcare Profitability

Why ICD-10 Matters

It’s an exciting time of healthcare reform for the United States and a lot of that excitement revolves around the transition from ICD-9 to ICD-10. If you’re asking yourself what is ICD-10 and why it is important, then you’ve come to the right place.

ICD-10 or a clinical modification of ICD-10 is the classification system currently being used by the majority of the world. The US is the only industrialized nation not using an ICD-10-based classification system.

ICD-10 matters to the coding professional because accurate code assignment is a coder’s responsibility, therefore the coder must be trained and ready to assign ICD-10 codes on the implementation date. Coding professionals must have in-depth knowledge of ICD-10, including applying the Official Coding Guidelines and Conventions.

There are two main reasons that the transition to ICD-10-CM/PCS is necessary:

  • Payers cannot pay claims fairly using ICD-9-CM since the classification system does not accurately reflect current technology and medical treatment. Significantly different procedures are assigned to a single ICD-9-CM procedure code. Limitations in the coding system translate directly into limitations in the diagnosis-related groups (DRG).
  • The healthcare industry cannot accurately measure quality of care using ICD-9-CM.
    It is difficult to evaluate the outcome of new procedures and emerging health care conditions when there are not precise codes.

    Most importantly, we have a mission to improve our ability to measure health care services provided to our patients, enhance clinical decision-making, track public health issues, conduct medical research, identify fraud and abuse and design our payment systems to ensure services are appropriately paid.

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