The ICD-10 is not a mere update in the coding system. ICD-10 is a streamlined set of codes that enables greater ‘specificity’ in indicating the exact medical condition of a patient and procedure done. This specificity will provide multiple benefits to the medical insurance billing and coding as well as healthcare industry.
Improved quality in clinical documentation: The ICD-10 coding system is much dependant on clinical documentation. Since thousands of diagnosis & procedure codes have been added to ICD 10, the precision of the codes depend on the clinical documents. So, with the implementation of ICD-10, quality of clinical documentation will improve.
Improved quality in healthcare: With ICD-9, the major focus was to improve reimbursements. But, ICD-10 coding setup supports ‘performance based payment’ system rather than aiming at returns. This will change the way healthcare is and will improve the quality of care.
Preventing healthcare fraudulent activities: National Healthcare Anti-Fraud Association (NHCAA) cites that anywhere between $70 billion and $234 billion is lost annually through healthcare frauds. Healthcare frauds are becoming common in the medical billing industry also, focusing majorly on medical insurance billing and coding manipulations involving medical billing services providing companies, hospitals and other healthcare entities. ICD-9 is more generic and allows tweaks to be made in coding to get better reimbursements. But, in ICD-10, the codes are specific and prevent manipulations to a great extent. This will over a period of time, have control over medical billing fraudulent activities as well.
Reporting features: Since the ICD codes are used for health surveillance and researches also, specificity in ICD-10 will reveal the exact health condition of people in the US. For instance, for ‘Brain tumor’, the ICD-9 CM assigned was generic. In ICD-10 CM, there are specific codes to mention if the ‘right’ or ‘left hemisphere’ is affected and whether it is ‘occurrence or recurrence’. All this will provide better insight to the healthcare department & help in efficient ‘disease management’.
Interoperability:
Sharing of health information with other countries is difficult to US with ICD-9, since all other countries except a very few, follows ICD-10 coding system. Now, with the implementation of ICD-10, US will be able to bridge the gap by sharing information across borders more efficiently and thereby empowering quality of care.
Great accuracy with fewer codes: ICD-10 will contain nearly 150,000 codes including CM & PCS. Though there are thousands of codes newly included, you can accurately describe a medical condition or encounter with fewer codes when compared to ICD-9 that needs more number of codes to indicate the same.