Why is it Crucial to Update the U.S. Medical Coding System

by | Published on Dec 16, 2014 | Medical Coding

Medical Coding
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The U.S. is one of the developed nations which is still using ICD-9, many others already having implemented ICD-10 codes. The transition from ICD-9 to ICD-10 by October 1, 2015 is not easy as ICD-9 is deeply rooted in healthcare system and to upgrade the existing systems with the new codes is technically difficult.

Implementing ICD-10 will benefit physicians, patients, and the healthcare system in general as the new codes will result in a more accurate reporting system with better support for the clinical decision. It will also pave the way for advancements in diagnosis and treatment options as well as improved care for healthcare consumers. In addition to coding and documentation improvements, it will improve quality measurement, and has an increased ability to prevent and detect healthcare fraud and abuse.

In the U.S., the use of electronic health records (EHRs) has increased significantly. EHRs play an important role in ICD-10 as they are the primary diagnosis entry point, with diagnoses recorded in multiple places such as problem lists and also physician-patient encounters. Physicians who employ web-based EHRs and billing services stand to benefit more during the ICD-10 transition. Since mappings from ICD-9 to ICD-10 are not the same, electronic tools like EHRs help the physicians to use the appropriate ICD-10 diagnosis and, in some cases, automatically converts from one code-system to another. This helps to ensure that the physicians are selecting the most specific ICD-10 code for a particular diagnosis category which can be billed accurately.

One thing the physicians must consider is that SNOMED-CT (Systematized Nomenclature of Medicine-Clinical Terms) code is also required to record the entries in addition to the ICD-10 code in EHRs that are 2014 certified. The clinical data encoded in SNOMED-CT can be mapped to ICD-10 codes which results in better claims submission and reimbursement.

Failure to update the medical coding system will result in issues such as delayed payments or even non-payment, higher rejected, denied or pending claims, reduced cash flows and ultimately lost revenues for the health care providers. Claims that fail to use ICD-10 diagnosis and inpatient procedure codes will not get processed.

Transitioning to ICD-10 is a very complicated process and proper planning is crucial. Support from a professional medical coding company can prove invaluable for a smooth transition to the new system. These medical outsourcing companies have professional coders who are well versed in the new coding and billing practices. They can help healthcare practices review their existing systems, identify what needs to changed, and implement these changes and gain the benefits that the robust ICD-10 code set brings.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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