|
|
|
SmartCodes FAQs
Q: What are ICD-10, ICD-10-CM and ICD-10-PCS?
A: ICD-10 is the most current classification system for reporting conditions, symptoms and diseases. It is developed and maintained by the World Health Organization, and has already been implemented in many other countries. ICD-10-CM is the US "clinical modification" of the WHO ICD-10 code set. The clinical modification was necessary to incorporate the level of detail needed in a morbidity classification and to support US data needs. ICD-10-PCS is a US creation, and is used for inpatient procedures.
Q: Why do we need ICD-10?
A: We have outgrown ICD-9 — after 30+ years, there is no room to add additional codes, and the codes in ICD-9 do not reflect current technology and medical treatment. ICD-10 is much more flexible and detailed. We cannot accurately measure quality of care using ICD-9-CM.
Q: What are the major changes from ICD-9 to ICD-10?
A: Diagnosis codes are expanded from 3-5 characters to 3-7 positions, from 13,000 existing codes to 68,000 codes. There is much greater specificity (e.g. diabetes mellitus codes have been split into 5 category codes and expanded). Modern terminology is used for descriptions. There are a number of combination diagnosis/symptom codes to reduce the number of codes needed to fully describe a condition. Codes are organized differently (e.g. injuries are grouped by anatomical site rather than injury category). ICD-10-PCS is a new code set, replacing volume 3 of the ICD-9-CM set. It increases code length from 5 to 7 positions, and each position (character) has a specific meaning. In ICD-9, there are 4000 procedure codes, varying from 3-4 digits, all of which are numeric. In ICD-10-PCS, there are 72,000 codes, 7 digits in length, and the codes are alphanumeric.
Q: Why are there so many more codes in ICD-10-CM?
A: ICD-10-CM was developed through a close collaboration with physician specialty groups who identified areas where greater detail was needed. In addition to assisting in tracking health care trends, analyzing quality issues and evaluating outcomes for a variety of technologies and treatments, the greater level of detail will reduce the number of documents being sent to support bills for services.
Q: What are the expected benefits of ICD-10?
A: Improving the quality of heath care data, leading to improved patient safety, quality of care and public health and bio-terrorism monitoring. We will be able to compare data with other countries who have already implemented ICD-10.
Q: How will the implementation of ICD-10-CM/PCS change the Medicare prospective payment systems?
A: CMS has estimated that, initially, PPS case mix groups not fundamentally change. Once CMS has collected enough claims data coded in ICD-10-CM/PCS, refinements will be made to the case-mix groups as needed.
Q: How will we be able to compare data coded in ICD-9 and ICD-10?
A: Maps between the two coding systems have been developed to help in longitudinal analysis. “GEMS’ (general equivalence mappings), developed by CMS, are intended to be used for large databases such as payment systems, payment and coverage edits, risk adjustment logic, quality measures and a variety of research applications involving trend data. Much of the mapping can be automated, but manual intervention will be needed depending on the purpose of the map.
Q: Who needs education on ICD-10-CM/PCS?
A: All providers, caregivers, coders, billing/financial office staff, clinical documentation specialists, quality and utilization review departments, patient registration staff, referral and authorization specialists, nurses, data analysts, other data users.
FAQs were developed using materials from CMS (Center for Medicare Services) and AHIMA (American Health Information Management Association), as well as other industry articles.
Additional System Resources
|
|
|
|
|
|
