By Vicki Battioli

PEORIA, IL – In the world of Healthcare, nothing is easy.  You can only continue to strive and look forward to better and more consistent practices.  ICD, is an example of an effort to better Healthcare practices. 

ICD stands for International Classification of Diseases. It is the diagnosis coding system, which became a requirement through Medicare in the 1980s.

This coding system is utilized as a means of processing the large and often complex volume of claims submitted to the federal government.

Shortly after Medicare began requiring use of the system, most commercial insurance providers followed suit, as a means of streamlining overall billing.

There have been different sets of ICD codes over the years, and the current set is the ICD-9 code set. The "9" representing the "9th Edition."

The US Department of Health and Human Services has developed a new set of ICD codes, which more accurately reflect today's medical climate. This is the ICD-10 system, and was to come into effect in 2013.

However, as many things do in our governmental system, there were delays to the implementation.

To fully understand these delays, we must first understand the elements of the new ICD-10 coding system.

Here is a short description and history.  ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list, by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.

The International version of ICD should not be confused with national Clinical Modifications (CM) of ICD that frequently include much more detail, and sometimes have separate sections for procedures.

The US ICD-10 Clinical Modification (ICD-10-CM), for instance, has some 68,000 codes. The US also has the ICD-10 Procedure Coding System (ICD-10-PCS), a coding system that contains 76,000 codes not used by other countries.

AHIMA (American Health Information Management Association) reports, in 2009, the U.S. Department of Health and Human Services (HHS) published the first ICD-10 final rule requiring the adoption of the new code sets for services rendered on and after Oct. 1, 2013.

This came after representatives of the industry requested that this date be moved back from the initial proposed date of Oct. 1, 2011, with those representatives claiming that the additional time was necessary to effectively and properly implement the changes.

Estimates of considerable costs and considerable benefits to the industry were applied to the process, with many of the costs falling on providers and many of the benefits accruing to public health entities and health plans, the timelines continuously were being delayed.

Work on ICD-10 began in 1983 and was completed in 1992.  However, ICD-10 went into effect in the U.S. on October 1, 2015.

Why is this so important?  ICD 10 is used in all medical billing.

Positives of ICD-10 in the billing process.   CGN Global has been working in healthcare for some time now.  ICD-10 can be a challenge but also a positive for providers.  The best thing about ICD-10 is that it allows providers to code to a higher level of specificity.  This might put more pressure on providers but it also makes sure their documentation is correct and accurate. 

This allows for many things:

• Decreased denials- Better and more specific documentation reduces denials, saves time and money for payers, providers and patients.
• Consolidation of Combination Codes- Assigning a combination code reduces the time it takes to find and apply multiple codes.
• Severity shows Necessity- ICD -10 has codes for acute, chronic, and recurrent. Using these codes helps to show medical necessity, which assists in getting approvals through insurances, etc.
• External Cause for Efficiency- External cause codes enable the payer to receive specific information regarding and injury. This will help payers determine the cause of injury that will help payers pay quicker and mitigate problems between the payer, provider and patients.
  (Example: Payers Insurance Companies)

This special coding system makes claims reporting quicker and easier. It is recognized by all parties in the medical field, ICD-10 codes are used by medical practitioners, laboratories, insurance companies, and specialists.

ICD-10 has been used internationally for years. (Refer to above ICD 10 Internationally)  We are now all on board with ICD-10 in the US and the changes it is making in our healthcare system.  This is a positive for all of us. 

CGN Global can help providers get more acquainted with these codes, for more positive outcomes to the providers and save money by decreasing errors in billing.  The diversification and specificity of the ICD-10 coding has not only given CGN Global insight from a provider basis, but has also allowed us to implement it into our work across all of our business practices. Overall, this creates a more efficient Healthcare system.

For CGN Global Healthcare information contact:

Vicki Battioli – Senior Consultant
Email: [email protected]

Tara Canty – VP of Healthcare
Email: [email protected]

John Osmond – Managing Principal
Email: [email protected]