The Advanced Guide To ICD-10 Coding System In Medical Billing

The International Classification of Diseases (ICD) was established by the World Health Organization to standardize medical records. Guess what? Now, the version ICD-9 coding was replaced by new version ICD-10-CM/PCS to modernize the medical coding pattern and adopt with the latest changes in today’s advanced healthcare marketplace.

The U.S healthcare industry made the switch to ICD-10 for coding, classifying, diagnoses, and procedures. This ICD-10 transition had drawn much speculation and confusion as it represented a momentous effect on healthcare providers, payers, and billing companies. You may be familiar with the expansion of new codes and changes with the coding structure. However, the impact of ICD-10 is a must thing to know about, and here is the evolution of ICD -10 coding and how it has impacted the healthcare industry.

The evolution of the ICD-9 Billing Codes System

WHO introduced the ICD-9 medical billing codes system (International Classification of Diseases-9th Edition with U.S. Clinical Modification – CM) in the year 1977 to help codify mortality and morbidity data for various diseases around the globe. By giving specific codes for diseases, injuries, and medical conditions, physicians could able to easily categorize the various services they administered to their patients. And this helps to justify the medical expenses billed on insurance claims. Later the ICD- 9 frameworks were modified for use in the U.S in the year 1979 and named as ICD-9-CM. This coding system had replaced all others used by American hospitals. By 1998, all U.S. doctors were required to utilize the ICD-9-CM codes to present their medical claims.

Benefits of ICD -9 coding system:

  • Providing a more steady strategy for recording clinical diagnosis and treatments
  • Improving clinic and healthcare providers billing procedures
  • Facilitating the payments of physician and emergency clinic bills by insurance providers and Medicare/Medicaid administrations

Drawbacks of ICD -9:

  • The 35-year old code set contains outdated terminologies and is conflicting with current clinical practice. 
  • The code length and alphanumeric structure limit the number of new codes that can be made, and numerous ICD-9 categories are already full.
  • The codes themselves need explicitness in the key boundaries to different disease manifestations, optimal claim reimbursement, value-based purchasing methodologies, and more.
  • The absence of detail constrains the capacity of payers and others to break down data, for example, health care utilization, viability, changes in population disease patterns, expenses and results, resource use and distribution, and performance estimation. 
  • The codes don’t give the degree of detail important to additionally improve the accuracy and to streamline automated claim processing.

The evolution of ICD-10 Billing Codes System

The WHO developed the ICD-10 billing codes system in the year 1993, a substantial upgrade from the ICD-9 design. At the time of release, the ICD-10 coding system was quickly accepted by almost all countries around the globe except the U.S., as they continued to utilize the version ICD-9 model.

The ICD-10 classification system is effective in the U.S. from October 1st, 2014. This coding system is more advanced and comprehensive than the previous versions. To issue the appropriate codes for the medical coders and the billers in the billing process, ICD-10 requires the doctors to be much more specific in their documentation of treatments.

Why coders should updated with the ICD-10 coding system?

The ICD-10 has created a tremendous impact in the U.S market on how documentation is handled by both medical professionals and the coding profession. Today, it’s medical billing and coding professional’s responsibility to find the appropriate diagnostic and procedural codes for billing purposes. So the coders and billers should be updated with the ICD-10 coding system, methodologies, and tools to continue to provide the high level of performance required for their profession.

Benefits of ICD-10 coding system:

  • Improve operational processes over the health care industry by classifying detail within codes to precisely process payments and reimbursements.
  • Update disease classifications to be reliable with current clinical practice, medical and technological advances.
  • Improve coding accuracy and particularity to arrange anatomic site, etiology, and seriousness. 
  • Support refined reimbursement models to offer equitable payment even for more difficult conditions.
  • Provide more detailed information to better analyze disease patterns and track and respond to public health outbreaks; the United States will join the rest of the developed world in using ICD-10.
  • Give more precise data to support the development and implementation of significant healthcare policies broadly.

Why is ICD-10 better than ICD-9?

With the introduction of ICD-10 codes, the total number of medical codes were expanded from 14,000 to 68,000 in ICD-10-CM and from 4,000 to 87,000 in ICD-10-PCS. Here are the top 3 comparisons of ICD-9 vs ICD-10.

1. ICD-10 has an incredible Coding Structure Than ICD-9 

The number of codes in ICD-9 was approximately 16,000 and the coding structure made it impossible to add to this number. So as medical technology advanced, ICD-9 remained too complex to keep up. Here comes the new coding structure to adopt the new data collection. 

For example, instead of stating in simple words ‘ A patient has a back pain’, you can be even more specific as to what kind of back pain a patient has and where. ICD-10 creates incredible benefits for doctors in building a history for patients that will also benefit them as they seek medical help later in their lives.

2. ICD 10 generates comprehensive Data than ICD-9

As discussed previously in the benefits section of ICD-9, it has many effective capabilities, but ICD-10 can generate even more comprehensive data that can be analyzed on a global level. This is important information that can be used to track diseases, prevalence rates, and other purposes.

3. ICD-10 Offers Flexibility In Terms Of Custom Codes Than ICD-9

ICD-9 didn’t have any facility to include bespoke codes or report unsupported diagnostic outcomes, which is something ICD-10 does quite well. In the regular course of patient experience, specialists will regularly confront diagnostic situations that are beside the point. This created a great challenge with ICD-9 as the specialist needed to approximately go with the nearest code related to the condition. With ICD-10, the new framework supports custom codes, which the specialist can input and later support with documentation during assessments.

Final Thoughts                 

Upgrading to the ICD-10 coding system in medical billing will enhance medical coding practices in the U.S. and place the country on par with other countries around the world. In like manner, medical coders and billers can upgrade their services to the medical profession by taking advantage of the advanced technology provided by the top professional coding services.