World Health Organization (WHO) usually publishes and updates standardized codes for classification of medical procedures and terminologies to be used by medical fraternity worldwide. When it comes to morbidity and mortality statistics, the International Classification of Disease 10th Procedure Coding System (ICD-10-PCS) is used. The system relies on three to seven alphanumeric for specification of medical procedures.
The first digit in the code is used to indicate the medical practice section which can be surgery, monitoring, measuring, administration or any other section. The next digits specify the body system, root operation, the body part, the approach used and devices used in that order. The last character (seventh) is used as a qualifying digit. The first three characters are usually so crucial and are stored in the ICD manual to help in reference.
The ICD-10 came as a replacement of the ICD-9 and is set to take effect on October 1, 2014 bringing with it a dramatic change in medical and healthcare sector in general. All the players from federal government, state governments, medical professionals and the insurance firms are set to be affected by this new coding system.
With the implementation of ICD-10 coding system, the hospitals are expected to have 87, 000 new codes for all in-patient procedure coding replacing the existing 8,660 CPT codes. The replacement however takes place for the in-patient procedures only. The new codes are not applicable for billing the radiologist components and out-patient services, procedures and studies. The implication is that identical procures are described by CPT codes for out-patients but with ICD-10 for in-patients.
Even with the transition, a number of players are not converting to ICD-10 codes. In this group are the auto insurance companies, the legal claims and workers comp which prompts hospitals to use a mixture of ICD-9, ICD-10, ICD-10-PCS and CPT codes for the management and billing system. The hospital management system must therefore have ability and knowledge required for automatic conversion of ICD-9 codes to 10 and back, Convert CPT code to ICD-10 or nine and back. This should be done with ease, efficiency and comfort for smooth operations and transition.
Given that the targeted year of full transition (2014) is here with us, you ought to have taken all the necessary steps towards this transition. There are only three alternatives if you are a healthcare player; to upgrade or replace the entire billing management system, outsource your services or opt for retirement.
As a healthcare provider, there are no other viable options other than ensuring compliance long before the October I, 2014 date set for new system enrollment. The other options are to outsource the services or retire from the industry all together which does not seem reasonable.
The implementation of ICD-10-PCS is however clouded with rumors and concerns that if confirmed to be true, could prove to be a big game changer in the industry. One of the recurring rumors is the possibility that the coding system will eliminate the so called unspecific codes that have long been used to support payable diagnosis. If confirmed, the CMS claims for code nine and zero may not get paid by insurance companies.
The first digit in the code is used to indicate the medical practice section which can be surgery, monitoring, measuring, administration or any other section. The next digits specify the body system, root operation, the body part, the approach used and devices used in that order. The last character (seventh) is used as a qualifying digit. The first three characters are usually so crucial and are stored in the ICD manual to help in reference.
The ICD-10 came as a replacement of the ICD-9 and is set to take effect on October 1, 2014 bringing with it a dramatic change in medical and healthcare sector in general. All the players from federal government, state governments, medical professionals and the insurance firms are set to be affected by this new coding system.
With the implementation of ICD-10 coding system, the hospitals are expected to have 87, 000 new codes for all in-patient procedure coding replacing the existing 8,660 CPT codes. The replacement however takes place for the in-patient procedures only. The new codes are not applicable for billing the radiologist components and out-patient services, procedures and studies. The implication is that identical procures are described by CPT codes for out-patients but with ICD-10 for in-patients.
Even with the transition, a number of players are not converting to ICD-10 codes. In this group are the auto insurance companies, the legal claims and workers comp which prompts hospitals to use a mixture of ICD-9, ICD-10, ICD-10-PCS and CPT codes for the management and billing system. The hospital management system must therefore have ability and knowledge required for automatic conversion of ICD-9 codes to 10 and back, Convert CPT code to ICD-10 or nine and back. This should be done with ease, efficiency and comfort for smooth operations and transition.
Given that the targeted year of full transition (2014) is here with us, you ought to have taken all the necessary steps towards this transition. There are only three alternatives if you are a healthcare player; to upgrade or replace the entire billing management system, outsource your services or opt for retirement.
As a healthcare provider, there are no other viable options other than ensuring compliance long before the October I, 2014 date set for new system enrollment. The other options are to outsource the services or retire from the industry all together which does not seem reasonable.
The implementation of ICD-10-PCS is however clouded with rumors and concerns that if confirmed to be true, could prove to be a big game changer in the industry. One of the recurring rumors is the possibility that the coding system will eliminate the so called unspecific codes that have long been used to support payable diagnosis. If confirmed, the CMS claims for code nine and zero may not get paid by insurance companies.
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