Overview of ICD-10

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The International Statistical Classification of Diseases and Related Health Problems has released its 10th revision in October of 2015. The code set has been through nine revisions so far and with the 10th revision out, medical practices can expect significant improvements such as care management, public health reporting, and research and quality measurement.

The ICD is the standard diagnostic tool for the analysis of the general health situation of population groups. Basically, it is a system that helps monitor incidences and prevalence of diseases and other health problems. With the new revision of the code available to doctors, they are trying to get used to the adjustments. Some of the most common adjustments that doctors are experiencing is making sure they have chosen the most accurate ICD-10 code to replace the previous ICD-9 code. However, it seems doctors are spending more time doing this than they feel they should. Investing in training of ICD-10 is extremely beneficial to eliminating any questions and potential setbacks in practice functionality. The most notable issue seems to be transitioning from the ICD-9 codes to the ICD-10 codes because now, doctors have to make sure they are processed correctly.

In order to remedy these issues, CMS, Centers for Medicare and Medicaid Services, has implemented a few short term solutions to the errors. Coding refinements and claims processing instruction updates should be in place by January 4th 2016, according to the CMS. However, some of these errors occur because the Medicare Administrative Contactors have not updated their LCD criteria. Once this is done, their claims will be reprocessed without any cost to the provider.

CMS recognizes the long process health care providers endure in order to transition to the new code set. The CMS were fairly confident in their preparedness for the transition but also recognized it would take several cycles in order to get a handle on how the transition went.

Many departments who thought they were prepared with solutions to translate one code set to the other code set. However, most departments used GEM’s to match I-9 code to the ICD-10 code. The CMS recommended to not use GEM’s because there are many deficiencies as a coding transition tool for coding.


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