MRI - Medical Reimbursement, Inc.
- ICD-10-CM transition is anticipated to meet the increased level of detail required to recognize advancements in medicine and technology, appropriate reimbursement, improved data quality for clinical and financial decision making, to support value based purchasing, and facilitate quality reporting.
- ICD-10-CM will encompass more precise documentation of clinical care and will potentially ensure more accuracy when determining medical necessity for the services provided.
- The differences between ICD-9-CM and ICD-10-CM are numerous, ranging from the number of coding categories to the structure of the codes.
- ICD-9-CM has 70,000 codes and ICD-10-CM has 140,000 codes.
- 7th placement codes in ICD-10-CM is A = initial, D = subsequent, S = sequela
- Documentation of diagnosis codes will have to be very specific with things such as site, acute or chronic, right or left, initial, subsequent, sequela, etc.
- ICD-10-CM uses every letter of the alphabet except “u”.
- Examples of things need in documentation of the diagnosis for fracture is as follows: initial encounter for closed fracture, initial encounter for open fracture, subsequent encounter for fracture with routine healing, subsequent encounter for fracture with delayed healing, subsequent encounter for fracture with nonunion, subsequent encounter for fracture with malunion, sequela.
- Examples of things needed in documentation of the diagnosis for things such as a femur fracture are as follows: initial closed, initial open, subsequent with routine healing, open fracture type I or II, open fracture type IIIA, IIIB, or IIIC, nonunion, malunion, sequela.
- Chest pain is broken down in categories such as central, anterior wall, stypical, ischemic, musculoskeletal, non-cardiac, on breathing, pleurodynia, precordial, wall (anterior), chronic, associated with significant psychosocial dysfunction, due to trauma, neoplasm related, postoperative, postprocedureal, post-thoracotomy.
- Will not be able to use unspecified codes if a more specific code is available. It is anticipated that insurance companies will deny claims if the ED provider submits an unspecified code and the hospital submits a more specific code.
- ICD-10 is set to start on October 1, 2014