ICD-9 codes were originally designed as a classification system to compile statistics, but as a code set, ICD-9 does not provide the information that payers desire for reimbursements or the type of data needed to monitor situations that include disease outbreaks by entities like the Centers for Disease Control (CDC) or the World Health Organization (WHO). In other words, it is now an outdated code set.
Implementation of the new International Classification of Diseases is mandatory and there are a number of compelling reasons for the transition, from patient management to identifying and addressing potential pandemics.
The codes were developed by the health division of the United Nations and the U.S. is one of the last countries to implement the codes, a move that has been criticized by other nations.
Codes For A New Era
The ICD-9 system is running out of number combinations to adequately describe new diseases and illnesses, terminology and technological advances since its implementation in 1979. The ICD-10 codes employ an alpha-numeric diagnosis and procedural system that’s more specific.
ICD-10 is designed for significantly more specificity and accuracy, which can increase the amount of documentation required for reimbursements.
The new system offers the ability to code for new diseases, techniques and procedures as they emerge in coming years.
Identifying Fraud, Trends And Abuse
The new codes provide additional oversight for payers, allowing them to identify instances of fraud, trends among practitioners, and individuals who are abusing the system.
It’s a tool that insurance companies have indicated can be used to significantly reduce the cost of healthcare.
Utilization of ICD-10 codes allows payers and professional organizations to monitor how clinicians are utilizing available resources in an effort to provide better patient care and effective management to reduce overall costs.
The new codes provide payers and government officials with a means to grade the individual performance of medical providers and facilities, establish reimbursement rates and set public health policies.
Improved Analytics For Practitioners
The new codes offer analytic tools for clinicians, allowing them to track patient illness, injury and disease trends.
Clinicians will have enhanced tools to monitor instances of everything from cancer and domestic abuse to diabetes and obesity rates.