Reimbursement
and Quality Problems with ICD 9
Six year old ICD 9system is getting
replaced with ICD -10.
Example
–
fracture of wrist
–
Patient fractures left wrist
•
A month later, fractures right wrist
•
ICD-9
-
CM does not identify left versus right
–
requires additional documentation
–
ICD -10
-
CM describes
•
Left versus right
•
Initial encounter, subsequent encounter
•
Routine healing, delayed healing, nonunion, or
malunion
–
fracture of wrist
–
Patient fractures left wrist
•
A month later, fractures right wrist
•
ICD-9
-
CM does not identify left versus right
–
requires additional documentation
–
ICD -10
-
CM describes
•
Left versus right
•
Initial encounter, subsequent encounter
•
Routine healing, delayed healing, nonunion, or
malunion
Example
–
combination defibrillator pacemaker device
–
Codes for this device are not in the cardiovascular chapter of ICD-9 CM with other defibrillator and pacemaker devices
–
Coders and researchers have trouble finding these codes with this type of erratic code assignment
ICD 10
-
PCS provides distinct codes for all these types of devices, in an orderly manner that is easy to
find
–
combination defibrillator pacemaker device
–
Codes for this device are not in the cardiovascular chapter of ICD-9 CM with other defibrillator and pacemaker devices
–
Coders and researchers have trouble finding these codes with this type of erratic code assignment
ICD 10
-
PCS provides distinct codes for all these types of devices, in an orderly manner that is easy to
find
Benefits
of Adopting the New Coding System
1.
Incorporates much greater
specificity and clinical information, which results in
1.
Improved ability to measure health
care services
2.
Increased sensitivity when refining
grouping and reimbursement methodologies
3.
Enhanced ability to conduct public
health surveillance
4.
Decreased need to include supporting
documentation
with claims
with claims
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