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Why is the Health-care Environment Changing? The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) uses o Diagnostic.

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Presentation on theme: "Why is the Health-care Environment Changing? The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) uses o Diagnostic."— Presentation transcript:

1 Why is the Health-care Environment Changing? The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) uses o Diagnostic purposes o Billing and reimbursement o Coverage adjudication o Compile statistics o Service quality evaluation Why change? o 30-years old – technology has changed o Many categories full o Not descriptive enough

2 ICD-9 to ICD-10 Comparison ICD-9ICD-10 Three to five characters in length Three to seven characters in length Approximately 13,000 codesApproximately 68,000 codes First digit numeric First digit is alpha, digits 2 and 3 are numeric; digits 4-7 are alpha or numeric Limited space for adding new codes Flexible for adding new codes Lacks detailVery specific Lacks laterality (i.e., codes identifying right vs. left) Has laterality (i.e., codes identifying right vs. left)

3 ICD-10 Readiness: Select Points to Keep in Mind o BWC will manage the processing of ICD-9 codes during a transition period after Oct. 1, 2015. This transition period will be for 90 days. The expectation is that only ICD-10 codes will be provided on claims and medical services documentation by Dec. 1, 2015.

4 Overall Benefits of ICD-10 o Enhanced ability to measure quality, safety & efficacy of health care o Reduction of need for extra documentation at reimbursement to describe patient’s condition o Streamlined payment system design o Improved research data for clinical trials and epidemiological studies o More efficient and less cumbersome health-care delivery systems o Major benefits that relate to electronic medical record, collection and storage of data o Prevention of fraud and abuse o Improved tracking of public health and risk

5 Online Resources o https://www.bwc.ohio.gov/provider/brochureware/IC D/Details.asp https://www.bwc.ohio.gov/provider/brochureware/IC D/Details.asp o http://www.cms.gov/Medicare/Coding/ICD10/index. html?redirect=/icd10 http://www.cms.gov/Medicare/Coding/ICD10/index. html?redirect=/icd10 o http://www.cms.gov/Medicare/Coding/ICD10/Provid erResources.html http://www.cms.gov/Medicare/Coding/ICD10/Provid erResources.html o http://medicaid.ohio.gov/PROVIDERS/Billing/ICD10/ ICD10Resources.aspx http://medicaid.ohio.gov/PROVIDERS/Billing/ICD10/ ICD10Resources.aspx


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