User:Icd10

WellCare ICD-10 knowledge base

Background

On January 16, 2009 HHS published a final rule adopting ICD-10-CM and ICD-10-PCS to replace ICD-9-CM in HIPAA transactions, effective implementation date of October 1, 2013. ICD-10-CM (Diagnosis Codes) will replace ICD-9-CM volumes 1 & 2 and ICD-10-PCS (Inpatient Procedure Codes) will replace ICD-9-CM volume 3. The transition to ICD-10 is occurring because ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full.

ICD-10 Features

Improve the data available for healthcare analytics. More granular and precise procedural and diagnostic coding will improve analytics across a number of domains: Fraud and abuse detection, identification/stratification of members for CM/DM, fine-grained approaches to reimbursement. Opportunities will not be realized until the provider community fully adopts usage of the enhanced code set. See tables below for feature comparisons on ICD-9 vs. ICD-10 code sets.