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The Importance of ICD-10

"Which of these vague codes in these vague categories is the one I should use?" This is a common question posed by coders today using ICD-9-CM diagnosis and procedure codes. According to Sue Bowman, RHIA, CCS, director of coding policy and compliance, American Health Information Management Association (AHIMA), that points to improved data quality as one of the key outcomes of the switch to ICD-10. Bowman and Nelly Leon-Chisen, RHIA, director of coding and classification at the American Hospital Association-both members of the cooperating parties who oversee maintenance of ICD-9-CM-spoke at AHIMA's ICD-10 Summit: Beyond Compliance to Strategic Advantage, held April 16-17 in Washington, DC. According to Bowman and Leon-Chisen, improved data quality is only one of a long list of benefits the U.S. will see in making this move. ICD-10-CM has these intrinsic benefits over the current system:

  • Greater level of specificity and clinical detail, and improvements in the capture of advances in medical technology
  • Medical terminology and classification of diseases have been updated to be consistent with current clinical practice
  • Comparability between mortality and morbidity data

Leon-Chisen said, "Medical coding is there to help present a picture." And with the breadth of use of the coding system today, improved data will support a host of health care needs including:

  • Measuring the quality, safety and efficacy of care
  • Designing payment systems and processing claims for reimbursement
  • Conducting research, epidemiological studies and clinical trials
  • Setting health policy
  • Operational and strategic planning and designing health care delivery systems
  • Monitoring resource utilization
  • Improving clinical, financial and administrative performance
  • Preventing and detecting healthcare fraud and abuse
  • Tracking public health and risks

ICD-10 will allow for increased adoption and benefit from new technologies as well. It is designed to work with structured terminologies like SNOMED-CT, which could accelerate the development and adoption of computer assisted coding. The increased specificity will allow for increased electronic data retrieval that will maximize the investment in databases and reduce the reliance on secondary record abstraction. For example, the diagnosis codes will indicate left and right, whether this is a new condition or a previous condition with current sequelae, and in some cases combine related conditions. The procedure codes allow for very specific information about the body part involved, the approach for a specific procedure, the device used and the basic procedure performed. 

Although ICD-10 is based on the same classification structure as ICD-9, both were originally developed by the World Health Organization and are modified for use in the U.S. (ICD-9-CM diagnosis codes and ICD-10-CM). ICD-10-PCS is a completely different coding system developed separately so the speakers cautioned not to expect it to look the same as the third volume of ICD-9-CM. Both ICD-10-CM and ICD-10-PCS are comprised of seven digit alpha-numeric fields that allow for an expanded and therefore more specific set of codes. 

Both Bowman and Leon-Chisen have been advocating for the move to ICD-10 for years and are excited the date is set for this important change. They are now fully engaged in the decisions that are required to ensure success in the transition.

Sandy Fuller is the senior vice president and chief operating officer at AHIMA.

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AHIMA Announces ARRA Web Page
AHIMA is actively monitoring, participating and developing resources to assist in understanding the key components of the American Recovery and Reinvestment Act (ARRA) and the impact on the industry and practice. Information on health care reform will be continually evolving in the next months. AHIMA's ARRA Web page is dedicated to providing a central resource center on leading-edge information, opportunities and requirements that will be generated by ARRA. Also, look to AHIMA's E-alert for updates on ARRA as they occur.

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