ICD-10 Diagnosis Codes

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After a patient’s first visit, during which Doctor Becerra usually takes x-rays, we schedule a follow-up visit so the doctor has time to evaluate the x-rays and test findings. The next step is to assign specific codes to a patient’s file; using these allow us to communicate to insurance companies what the exact diagnosis is for the patient’s condition. For the last few decades, all medical practices in the US have been using the ICD-9 system, but now we’re transferring over to the ICD-10 system, beginning October 1 of this year. It’s a huge shift, but in the end it’s going to help us be more accurate in our records for patients!

Why the change?

The ICD-10 system isn’t “new” per se; it’s been in use by other countries around the world for about ten years now! The United States is one of the last countries to switch over, and it’s something that can’t be delayed any longer. With the increase in possible diagnoses, as well as more complications that come with each condition that would be specific to a patient, the ICD-9 system just isn’t specific enough.


What changes are in ICD-10?

Really, it’s all about being more specific. Instead of the ICD-9 codes that were usually four or five digits, the ICD-10 codes can be anywhere from three to seven digits. They start with a letter, which denotes the specialty; we will mostly be using M codes for the musculoskeletal system. After that, two numbers determine the condition, followed by a decimal point and up to three more numbers. Those three numbers are the important parts that give specificity!

For example: sciatica. For ICD-9, it was simply 724.3. Now, with ICD-10, there are three possible codes: M54.30, M54.31, and M54.32. This means, respectively, sciatica on an unspecified side, sciatica on the right side, and sciatica on the left side.

Another addition with ICD-10 is the ability to add codes that show how a condition occurred. A few weeks ago, we showed a few entertaining ones – the most notable is “bitten by a duck”. Of course, a bit funny, but there are other codes that would be applicable to our office.

Why so late compared to the rest of the world?

Originally, this transition was supposed to happy in October of 2012. CMS, however, or Center for Medicare Services, put it on hold, desiring to focus on meaningful use (another aspect of the movement to being more specific with documentation) instead. The new date was for October of 2014, but then Congress delayed it by one more year, needing to complete more testing to ensure that claims will process through correctly so we don’t run into too many errors and delays. Now, our new date is October 1, 2015, and it’s solid this time. September 30th will be the last day we bill with ICD-9 codes!

If you think this sounds like a bit of a headache, you would be right. But in the end, all of this will be worth it, since the new coding system is not only accurate, but also more streamlined! By the time October 1st comes, we’ll all be prepared and comfortable for the transition. Now all we can pray for is smooth sailing when the time comes to send out claims!

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