Vbrooks-Hs225-Unit 8 Final Project

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VBrooks-HS225-Unit 8
Running Head: ICD-9-CM VERSUS ICD-10-CM

ICD-9-CM versus ICD-10-CM

Valerie D. Brooks

HS225-01 Unit 8 – Final Project

Kaplan University

July 12, 2011

Abstract

Most of the codes we see in the United States today are version 9, called ICD-9-CM codes. With few exceptions, the paperwork we receive when we leave a doctor’s office will contain both CPT codes (Current Procedural Terminology) to describe the service that was rendered for billing purposes, and ICD-9-CM codes to describe why that service was provided. Further, most death certificates filed since, 1977 will have an ICD-9 code on them.

The most current list of codes in use is ICD-10. This list was first used in the United States in 2007. Minor revisions added to ICD-10 codes were made available in early 2009 by the NCHS. Globally, most other countries in the world have implemented the ICD-10 codes. There are some major differences between the two code sets, the transition is very expensive, and most American providers have not yet upgraded to the ICD-10 system.

ICD, was develop by the World Health Organization, is designed to promote international comparability in collecting, processing, classifying and presenting mortality statistics. ICD-10 was released officially by WHO in 1993 and has been implemented in many European countries. In 1999, ICD-10 was implemented officially in the United States for reporting the cause of death on death certificates, but it has not been implemented to submit insurance claims.

ICD-10-CM is the U.S. "clinical modification" to ICD-10 to facilitate its use for morbidity data. ICD-10-PCS--procedure classification system-- were developed by 3M Corp. under contract to the U.S. Department of Health and Human Services.

In November 2003, the National Committee on Vital and Health Statistics, the public advisory body to the secretary of Health and Human Services, recommended the department move forward with rule making to adopt ICD-10-CM/ICD-10-PCS as standards under the Health Insurance Portability and Accountability Act of 1996 to replace the current uses of ICD-9-CM. Adopted, ICD-10-CM/ICD-10-PCS would have to be used on all HIPAA-compliant transactions, including insurance claims.

Several reports have been published estimating the cost of implementing the new codes. Based on a review of this literature: • A reasonable preliminary estimate of the total cost to the healthcare system would be $3.2 to $8.3 billion; • The implementation will cost the Medicare program between $200 and $220 million; The implementation will cost state Medicaid programs $1 to $3 million each; and

• Requiring health care providers and private payers to speed up implementation has the potential to increase costs and result in a less effective implementation.

The US is the only industrialized nation not using an ICD-10–based classification system for morbidity purposes. This makes it difficult to share disease data internationally at a time when such sharing is critical for public health. The US’s ability to track and respond to global threats in real time is thus limited.

The US belongs to the World Health Organization, which requires member states to notify the organization of all events that constitute a public health emergency of international concern and to respond to requests for verification of information regarding such events. The vision is that every country should be able to detect, rapidly verify, and respond appropriately to epidemic-prone and emerging disease threats to minimize their impact on the health and economy of the world’s population.3

Adoption of ICD-10-CM also would facilitate international comparisons of quality of care and the sharing of best practices globally.

Overall, ICD-10-CM is more effective at capturing public health diseases than ICD-9-CM. It is more specific and fully captures more of the nationally reportable public...
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