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.
The 10th Procedure Coding System is to be used for the in-patient services only. They will not be applicable when it comes to billing the radiologist components. The other significant area where they are not applicable is on the out-patient services. The implication is that a similar procedure performed on in-patient and out-patient is differently coded. For out-patients, CPT is used but ICD-10 is used for in-patients procedures.
Given that some players like the auto insurance, legal claims and workers comps are not expected to convert to the new coding system, the hospitals are likely to use CPT, ICD-9, ICD-10-CM and ICD-10-PCS all at the same time. This calls for capacity evaluation, ability training and general knowledge in the part of healthcare providers to keep up to the demand of converting from one coding system to the other and back in an efficient and easy manner.
As an industry player, you have only three options of which only one is viable. You can choose to upgrade or completely change the billing management system, outsource the services or choose to retire before the transition date comes.
The last minute rush, expect confusion and delays as hospitals, clinics, surgery centers, insurance companies, the CMS, the State Medicaid and all other healthcare providers try to comply in October 1, 2014 should be avoided. There are concerns arising from the implementation of ICD-10-PCS such as the possibility of using detailed information from this code to exclude coverage by the government and private insurance.
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.
The 10th Procedure Coding System is to be used for the in-patient services only. They will not be applicable when it comes to billing the radiologist components. The other significant area where they are not applicable is on the out-patient services. The implication is that a similar procedure performed on in-patient and out-patient is differently coded. For out-patients, CPT is used but ICD-10 is used for in-patients procedures.
Given that some players like the auto insurance, legal claims and workers comps are not expected to convert to the new coding system, the hospitals are likely to use CPT, ICD-9, ICD-10-CM and ICD-10-PCS all at the same time. This calls for capacity evaluation, ability training and general knowledge in the part of healthcare providers to keep up to the demand of converting from one coding system to the other and back in an efficient and easy manner.
As an industry player, you have only three options of which only one is viable. You can choose to upgrade or completely change the billing management system, outsource the services or choose to retire before the transition date comes.
The last minute rush, expect confusion and delays as hospitals, clinics, surgery centers, insurance companies, the CMS, the State Medicaid and all other healthcare providers try to comply in October 1, 2014 should be avoided. There are concerns arising from the implementation of ICD-10-PCS such as the possibility of using detailed information from this code to exclude coverage by the government and private insurance.
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