I.C.D.-10 and the Future of Medical Billing 06/14

Later this year a transformation is coming to the mysterious world of medical billing. Overnight, the entire health care system, Medicare, Medicaid, private insurers, hospitals, doctors and all the middlemen, will switch to a new set of computerized codes used for determining what illness’ patients have and how much they and their insurers should pay for a specific treatment.

The changes are unrelated to the Obama administration’s new health care law. But given the unsteady start of the federal health insurance website,, some doctors and health care information technology specialist’s fear there will be major disruptions to health care delivery if the new coding system; which is also heavily computer-reliant, isn’t put in place properly.

The new set of codes, known as I.C.D.-10, allows for much greater detail than the existing code, I.C.D.-9, in describing illnesses, injuries and treatment procedures. That could allow for improved tracking of public health threats and trends, and better analysis of the effectiveness of various treatments.

There are health care professionals that believe the need to prepare for I.C.D.-10, the Affordable Care Act and the need to achieve meaningful use of electronic health records all at once could overwhelm computer staffs throughout the health care industry.

The switch to I.C.D.-10 has already been postponed by a year. It was originally scheduled to go into effect Oct. 1, 2013, which would have coincided with the rollout of the insurance website. I.C.D.-10 is the 10th revision of the International Classification of Diseases, which is issued by the World Health Organization, though countries can modify it.

Having a common global code allows for easier collection, comparison and analysis; of the causes of death and illness. Most other countries have already adopted I.C.D.-10, at least for record-keeping and in some cases for reimbursement.

When it first proposed moving to I.C.D.-10, the Medicare and Medicaid Services office estimated it would cost the government and industry $1.64 billion over 15 years on training, software changes and lost productivity. But it also said the system would bring $4 billion in benefits over that time, from more accurate claims and improved health care.
While I.C.D.-9 had a single code for certain repairs to blood vessels in the head and neck, I.C.D.-10 allows specification of the particular vein or artery and the particular procedure used. Extra codes allow recording of whether a patient was visiting the doctor for the first time or a subsequent time for a particular problem, and whether broken arms and some other injuries occur on the left or right side of the body.

The transition could be tougher for doctors, because they will have to be more specific in describing a patient’s condition.

With all of these changes set to take place in the near future, the dedicated staff here at ECM is prepared to handle any changes to come in the medical billing world.

Source: The New York Times Company
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