ICD stands for International Classification of Diseases. ICD-10 is the 10th edition of the World Health Organization’s International Statistical Categorization of Diseases and Related Health Problems (ICD). It includes disease codes, signs and symptoms, aberrant findings, complaints, social situations, and external causes of harm or sickness. ICD-10 development began in 1983, was approved by the 43rd World Health Assembly in 1990, and was first used by member states in 1994.
It supersedes the International Classification of Diseases, Ninth Revision (ICD-9) from the 1970s. ICD-10 is a thorough rewrite of its predecessor, ICD-9. It increases clinical communication by delivering more information per code as well as improved assistance for care management, quality monitoring, and analytics. It also improves one’s understanding of risk and severity.
ICD-10 Medical Code Set
Many countries now employ national variants of ICD-10, each tailored to their specific healthcare system.
The Centres for Medicare & Medicaid Services (CMS) and the National Centre for Health Statistics (NCHS) developed the US version of ICD-10, which includes two following two medical code sets:
- ICD-10-CM
- ICD-10-PCS
On October 1, 2015, ICD-10-CM and ICD-10-PCS became mandatory for medical claims reporting. However, the two code sets are drastically different. These codes not only respond to various diagnoses, but they also can deliver better and more up-to-date data for overall patient and health care improvement.
ICD-10-CM
The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a system used by physicians and other healthcare practitioners in the United States to classify and code all diagnoses, symptoms, and procedures documented in association with hospital care.
ICD-10-CM Diagnoses Codes are made up of three to seven characters. The first character is alphabetic, 2nd character is numeric, and characters 3 through 7 are alphabetic or numeric, with a decimal after the third digit.
ICD-10-CM codes must be supplied to the payer for a medical provider to receive compensation for medical services. While CPT® codes represent the services offered to the patient, ICD-10-CM codes represent the diagnoses that justify the treatments rendered as medically essential.
ICD-10-PCS
It is the International Classification of Diseases Procedure Coding System. This code set is only in hospital inpatient settings.
Volume 3 of the International Classification of Diseases, Ninth Edition, Clinical Modification is being replaced by ICD-10-PCS. These codes are alphanumeric and contain seven characters. ICD-10-PCS is designed for use by health care professionals, organizations, and insurance programs. These codes are used for reporting morbidity data and invoicing in several clinical and health care applications.ICD-10-PCS codes are updated every year.
ICD-10 Code Structure
ICD-10-CM codes range from 3-7 characters in length. Every code starts with an alpha character that indicates the chapter to which the code belongs. Numbers make up the second and third characters. Numbers or letters can be used for the fourth, fifth, sixth, and seventh characters.
Example;
S53.521A: ICD-10 code for torus fracture of the lower right end of the right radius.
A37.81: This ICD-10 code deals with whooping cough due to other Bordetella species with pneumonia.
Importance Of ICD-10 Codes
The importance of the ICD-10 code system can be gauged by its use in numerous fields such as quality management, healthcare, IT, and public health.
- The ICD-10 code system provides precise and up-to-date procedures to reduce healthcare costs and maintain equitable reimbursement practices. The new code assists healthcare providers in identifying individuals who require prompt illness management and tailoring successful disease management programs.
- ICD-10-CM has been adopted internationally to facilitate the delivery of quality health care and global comparability.
- ICD-10-CM is more specific than the previous edition (ICD-9-CM) and captures public health problems, particularly those associated with external damage, such as terrorism.
- Code analysis is vital to research and development and ICD-10 codes are very important in research. The code framework and logic allow fewer coding errors, which aids research and development studies.
- The ICD code system upgrade version improves health policy decision-making by providing improved organization supervision and achievement data.
- The ICD-10 classification system aids in the reduction of drug errors, as well as the improvement of therapy alternatives and disease outcomes.
- The ICD code system reduces treatment and claim costs in health policy and operational and strategic planning.
- It Improves payment systems by handling claims.
- That helps in reducing claim submissions.
- ICD-10 codes were created primarily for reimbursement purposes to provide a logical framework for payment procedures.
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