On October 1, 2014, everyone who is part of the U.S. health care system will be affected by the industry’s transition to ICD-10 Codes. This is a major change and anyone using medical diagnosis and procedure codes, and covered by the Health Insurance Portability and Accountability Act (HIPAA), will be impacted. Providers billing Medicare, Medicaid and private health insurers will all be covered. Workers’ Compensation, Life and Disability insurers will see the effects even though they are not technically covered by HIPAA..
This mandated transition is occurring because ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures. Advocates claim that the change to ICD-10 coding is necessary to more accurately document clinical information, more precisely identify diagnoses and procedures, eliminate outdated terms and remain consistent with modern medical practice.. In fact, CMS has pointed out that ICD-10 Coding promises to:
Offer greater opportunity for evidence-based practice
Create less burden on clinicians to provide detailed supporting documentation
The result is that physicians and all medical records will see significant increases in the number of codes (think about 68,000 codes in ICD-10 up from about 13,000 codes currently in ICD-9), and more focused medical terminology. Compounding the confusion is that the change to ICD-10 does not affect CPT coding for outpatient procedures.
So, what does this mean to attorneys litigating cases involving medical records and disabling conditions?
Beginning on October 1, 2014, anyone relying on medical records and medical billing documentation will have to redouble efforts to understand what the codes are describing.
As we have seen with the wide-scale adoption of electronic health records, there promises to be substantial effects on provider documentation and meaning.
It will be more important than ever to thoroughly extract accurate information from medical records and related billing detail describing the new ICD-10 codes to pinpoint injury severity and complexity of related procedures.
For now, there continues to be much uncertainty, especially the readiness of health care providers to fully and accurately adopt ICD-10 coding. Obviously, with the direct link to reimbursement, they are incented to do so. Yet, due to the enormity of the conversion and likely inconsistent readiness among physicians, hospitals and other providers in your market, a new level of scrutiny is warranted.
To access additional resources, visit www.cms.gov/icd10.
As a former Hospital Administrator, Rick Litzky, VP of Business Development at Medical Legal Spider, brings a unique perspective to our changing healthcare delivery system and effects on medical injury litigation. Please contact Rick directly to answer questions, request future research on a topic of your interest or to learn more about Medical Legal Spider’s innovative solutions for improving the medical review experience. He may be reached at 855-677-4337 or firstname.lastname@example.org.