Ultimate Guide About ICD-10

ICD-10 CM or the International Classification of Diseases, 10th Revision, Clinical Modification is the current ICD coding system used in hospitals in most countries today. As a medical practitioner, you need to understand how it works and how it is used to maximize its benefits.

If this is your first time to encounter ICD-10 CM or simply want to know more about it, you have come to the right place. Scroll down to find out more about what ICD is, ICD Coding Guidelines, who uses ICD, why ICD exists, and other relevant information you need to know!

What is ICD-10?

ICD is a system developed by the World Health Organization (WHO) for classifying and coding disease symptoms, diagnoses, complaints, irregularities, and procedures.

Endorsed in May 1990 by the 43rd World Health Assembly, ICD-10 is a system currently adopted by the American healthcare system as well as those of more than 100 other countries around the world. It has been cited in at least 20,000 scientific articles.

The codes of ICD are essential in recording medical diagnosis and procedure information on different patient cases. Statistical analysis, proper documentation, and correct billing relies on accurate coding.

At least one Diagnosis code and/or Procedure code must be assigned for a patient to bill for a hospital visit. ICD is a global language regarding health information and a standard used in morbidity and mortality statistics.

Aside from its application in research, defining and studying diseases, and clinical care, ICD is also used as a reference for the management of healthcare, monitoring of outcomes, and allocation of resources.

What is the purpose of ICD?

The primary purpose of ICD is to promote an international standard in the collection, classification, definition, processing, and reporting diseases and health conditions. It a universal language that serves as the foundation for comparing and identifying patterns in health trends and statistics worldwide.

The ICD is regularly revised and updated so that it can accurately reflect new discoveries and advances in medical science. It allows medical practitioners to keep count of diseases, deaths, symptoms, injuries, contributing factors that affect health, and causes of disease.

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Basically, ICD covers all disorders, diseases, injuries, complications, and other related health conditions and organizes these comprehensively for easier referencing. Despite language barriers and the varying number and types of codes in every country, the standard grouping and coding of diseases provided by ICD are useful in:

• Easy storage, recovery, and analysis of health data;
• Decision-making based on hard evidence and past case studies;
• Sharing and comparing data among various countries, regions, hospitals, and settings; and
• Comparisons of health information in the same places across time periods.

ICD is also used in monitoring the prevalence and incidence of diseases, observing trends in resource allocation and reimbursements, and keeping track of safety and quality guidelines.

Who Uses ICD?

• The primary users of ICD include:
• Physicians
• Nurses
• Researchers
• Health workers
• Policy-makers
• Health information managers
• Health programme managers
• Insurers

The ICD-10 Videos You Need to Watch

• A summary and the detailed description of ICD 10 coding guidelines are given in this video from the American Academy of Professional Coders (AAPC): What is ICD-10.  

• This Introduction to the ICD-10 Coding animated video was created by the Centers for Medicare & Medicaid Services (CMS). It explains the advantages of using ICD-10 medical codes.    

• To understand and learn the Basic Steps in Coding ICD-10 CM, watch this video.

A Comprehensive ICD-10 Review

The ICD-10-CM 2020: The Complete Official Codebook is a book published by the American Medical Association (AMA) containing the updated code set for easier and accurate diagnostic coding.

The codebook is recognized as the foundation of medical recording to determine coverage and ensure proper reimbursement. It contains 21 aptly organized chapters in the Tabular List of Diseases and Injuries to provide quick and straightforward navigation and reduce the challenge of coding accurately.

Supplementary appendices are also included, examples of which are pharmacology listings, coding tutorials, a list of valid 3-character codes, and additional information about Z-codes.

It comes with a full list of code changes for a quick overview of the deletions, additions, and revisions of codes from the previous revision. It has the new Quality Payment Program (QPP) symbol on the tabular section for identifying associated diagnostic codes under MARCA.

The book also provides more than 100 coding tips and more than 300 new definitions and illustrations designed to highlight critical information about a disease, process, or injury.

The well-thought-out format includes full-color illustrations, color-coding, visual alerts, and symbols to identify coding instructions and notes, additional character requirements, and codes associated with Medicare Code Edits (MCEs), CMS Hierarchical Condition Categories (HCC), specified and unspecified codes and manifestation codes.

The Placeholder X used for three, four or five-character codes that need a seventh character extension notifies the coder of an important ICD-10-CM convention.

Lastly, the book also has coding guideline examples and explanations, a muscle/tendon translation table, and supplementary appendices.

Frequently Asked Questions About the ICD-10 Codebook

1. Why is there a transition from ICD-9 to ICD-10?

The transition was not optional but completely necessary because ICD-9, which was developed in 1970, was simply outdated and was based on obsolete medicine and technology. It does not have the necessary details for modern treatments and cannot accommodate new codes.

ICD-10 provides greater detail and accurate, up-to-date descriptions of diseases and injuries as well as all of the possible contributing factors, socioeconomic impacts, and lifestyle-related issues. ICD-10 also has the space for technological innovations and is made better to support health information exchange among countries.

2. Is ICD-10 more challenging to use than ICD-9?

ICD-9 and ICD-10 codes have entirely different structures. While ICD-9 codes are generally numeric with 3 to 5 digits, ICD-10 codes are alphanumeric and contain 3 to 7 characters. The process coding is still the same, although ICD-10 requires additional documentation and provides more information for the chosen codes, like the location of injury and external circumstances.

3. What will I need to include in my documentation?

Generally, you need to include details like ordinality and laterality, but requirements vary depending on specific conditions. For example, under asthma, you need to identify if it is mild, persistent, moderate persistent, severe persistent, or intermittent whereas, for fractures, you only need to determine the Gustilo classification and fracture type.

4. What is the difference between ICD-10-CM codes and ICD-10-PCS codes, and which are used in an outpatient setting?

International Classification of Diseases, 10th Revision: Clinical Modification (ICD-10-CM) and International Classification of Diseases, 10th Revision: Procedure Coding System (ICD-10-PCS) are the two different code sets of ICD-10. All information provided by the American Physical Therapy Association (APTA) is associated with the ICD-10 CM codes. This is also the code set referred to when most people talk about ICD-10. This is also used for all healthcare settings in the US. On the other hand, ICD-10-PCS is only used in hospital inpatient settings and are not necessary for outpatient settings.

5. Can I use multiple codes?

Yes, you can use as many codes as needed to adequately and accurately describe the patient’s condition including the problem, diagnosis, or other possible reasons for the consultation. You can also use additional codes for describing any coexisting conditions. However, pay attention to notes that come with the codes since some codes cannot be used with other codes.

6. Can the ICD-10 code change throughout the episode of care?

Yes, diagnoses often become more definitive or conclusive throughout the health service. You can change the codes or add diagnoses along with the corresponding ICD-10 codes. You also need to add codes for symptoms and signs that were identified but were not initially part of the diagnostic codes.

Conclusion

Overall, the ICD-10 is an international standard system of coding used in studying, recording, sharing, comparing, and analyzing health information. It is a vital component of today’s health care system and the medical field.

Meta-description: The International Classification of Diseases (ICD) is the complete official code system used by healthcare providers all over the world. This article will teach you more about the ICD 10 Coding Guidelines, the uses, features, benefits, and more!