On July 31st, 2014, the U.S. Department of Health and Human Services (HHS) issued a rule finalizing Oct.1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the international Classification of Disease.
ICD-10 will provide an enhancement platform for physician practice and enhance clinical documentation enabling physicians to better capture patient visit details and lead to better care coordination and health outcomes. Understanding patient encounters and preparing for the transition will be critical to the financial stability of each practice.
ICD-10 represents a significant change that impacts the entire health care community. While many providers, including physicians, hospitals, and health plans, have completed the necessary system changes to transition to ICD-10, the time offered by Congress and the final rule ensure all providers will be ready
There are several differences between ICD-9 and ICD-10. ICD-10 CM (US version) has roughly 69,000 diagnostic codes, as opposed to 13,000 in ICD-9. With ICD-10, the terminology has been modernized and has been made consistent throughout the code set. There are codes that are a combination of diagnosis and symptoms, so that fewer codes need to be reported to fully describe a condition. ICD-10 code set is much better at describing the current practice of medicine, and has the flexibility to adapt as medicine changes.
There are many reasons to prepare for ICD-10. On a clinical basis, it provides new insights into patients and clinical care due to greater specificity, laterality, and more detailed documentation of patient diseases. It enables patient segmentation to improve for higher acuity patients and improves design of protocols and clinical pathways for various health conditions. On an operational basis, it supports practice transition to risk-sharing models with more precise data for patients and populations and affords more targeted capital investment to meet practice needs through better specificity of patient conditions. On a professional basis, ICD-10 provides more specific data to support physician advocacy of health and public health policy, aids in the prevention and detection of healthcare fraud and abuse, and provides clear and objective data for credentialing and privileges. On a financial basis, it may reduce audit risk exposure by encouraging the use of diagnosis codes with a greater degree of specificity as supported by the clinical documentation, provides objective data for peer comparison and utilization benchmarking, and allows better documentation of patient complexity and level off care, supporting reimbursement for care provided.
Information provided and to more learn more about ICD-10, please visit http://www.roadto10.org
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