What do i need to know? ICD-9

So, continuing in our "What do I need to know?" series, today we will look at the ICD-9 (and soon to be ICD-10) manuals.

Like the CPT, Current Procedural Teminology (see previous post), the ICD-9 stands for International Classification of Diseases.  It is a comprehensive listing of all diseases, conditions, pre-conditions, injuries, post-injuries, and medical conditions that we code.  These codes are required to go on all of our medical claims  Why, you ask?  Good questions.  The answer is actually two-fold.

First, many insurance policies are either limited coverage or have certain exclusions.  For example, if you have a chronic back condition, and you purchase a private policy, it is likely that they will exclude any treatment related to your back, since it was a pre-existing condition.  By placing your diagnosis codes on the claim, they can tell instantly whether the treatment that you received is related to your back, and therefore determine whether it should be payable or not.  Both diagnosis and procedure codes are a quick, easy way of identifying what is wrong, and what was done at the doctor's office or hospital.

The second reason is the one that was described in the last post.  The federal government, and the WHO, World Health Organization, both track global trends in healthcare.  This way they can be globally prepared for things such as pandemic flus, and global outbreaks.  It is a way of containing things like small pox and bubonic plague.  When the bird flu broke last year, China actually restricted travel to keep the flu outbreak out of their country.  Now before you panic, when things are reported to the government, they are not reported with your name and address.  There is no 'big brother' action going on here.  They are reported as "X numbers of persons are reported as new cases of breast cancer", and "X number of people died from diabetes this year".  Have you ever seen the comercials that state something like "more teens died this year from drunk driving, that from lung cancer, dog bites, and falling off a cliff, together,"?  So, how do they get these figures?  From the ICD-9 reporting process.  It is also a way of determining where public monies should go for research.  Black lung disease is a federally supplemented condition that coal miners suffer from.  How many black lung patients do we have?  We know from the ICD-9.

Currently in use now is the ICD-9.

Soon to be converted to the ICD-10.

The books can be daunting at first glance, but spend some time looking through them, and you will see that they are not as intimidating as they seem.  Next post, how to get around in these books.

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/ 

Move over ICD-10, here comes ICD-11

ICD-9, ICD-10, and now the ICD-11.  What are they?  Who uses them?  And what are they for?
Good questions...
Right now here in the US we us the ICD-9.  It stands for International Classification of Diseases.  It is the book full of thousands and thousands of codes for every disease, condition, pre-condition, injury, post-injury, or medical circumstance that you could imagine.  (For example:  pedestrian vs. cow... no kidding!).  We use the codes that are assigned to these medical conditions for billing on our claims.  The ICD-10 actually came out a few years ago, but we (as a country) are still using the ICD-9.  Why?  My inquiring brain could not fathom this, so I did some checking.  What I found was interesting.
The ICD-9 was not even created here in the US.  It was created by the WHO, World Health Organization, to track global epidemics such as pandemic flus, Ebola Virus, and AIDS.  Other countries use it for reporting purposes, whereas we use it for actual billing.  Here in the US, the Department of Health and Human Services actually owns the copyright for the printed materials that we use, but the content is available worldwide.
Since we use it for billing, conversion to the ICD-10 is massive.  To complicate things even further, the new ICD-10 will also contain procedure codes for the first time (outpatient).  Conversion on a national level is massive and has proven to be so daunting that we have yet to have it implemnted.
So, since the ICD-11 is slated to be out in 2015 for use globally, and we have not yet implemented the ICD-10... I say we just hold off a few more years and jump straight to the ICD-11.  What could it hurt?  We've held on to the ICD-9 for so long, what's a couple more years?
It gives new meaning to the phrase "that's the way we've always done it."

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/