The 3 Practical Ways in Which ICD-10 Codes Are Put to Use

Medical coders have a fascinating job – at least if you are into that sort of thing. They translate services performed by a clinician into a series of alphanumeric codes that are eventually passed on to the billing department for conversion into medical claims. Coders work with many different code sets, including ICD-10 and CPT. But why use the codes? Why not just write things out in plain English?

 

The answers can be found simply by looking at the practical ways in which ICD-10 codes are put to use. Our healthcare system could function without ICD-10-CM codes, but it would be less efficient – and arguably less effective. That notwithstanding, here are three practical uses for ICD-10 codes:

 

For the record, medical code sets were originally developed to help providers better communicate with third party payers. Decades ago, it became apparent that medical billing was having trouble keeping up with the expansion of diagnoses and procedures. Organizations like the American Medical Association (AMA) and World Health Organization (WHO) began developing codes to standardize things.

 

Today, this all translates into ICD-10 codes being used largely for payer reimbursement. A payer, like Medicare or a private insurance company, has neither the time nor interest in wading through clinician notes to verify information against insurance claims. Doing so would be extremely complicated.

 

The use of ICD-10 codes makes it fairly easy to compare a clinician's diagnosis against the procedures and services provided for treatment. If the ICD-10 and CPT codes are aligned (according to payer policy), the payer pays the claim. If they do not align, the claim might be denied.

 

ICD-10 codes can also be leveraged to help manage patient care. Note that the codes are diagnosis codes, meaning that most diseases or health conditions are assigned a unique code. Clinicians looking at a patient's medical history can glean information from some of the codes pertaining to previous visits.

 

For example, a code for a chronic illness is likely to follow a patient across multiple healthcare providers. Examples of chronic illnesses include heart disease and diabetes. Because the codes for these diseases follow patients around, it is easier for multiple healthcare providers to simultaneously manage the person's health just by looking at their records.

 

This can be both good and bad. It is good when a patient is facing a life-threatening emergency and information about a chronic condition is required to provide proper treatment. But it is not so good when a doctor or nurse focuses so much on the chronic condition that they ignore the reason for the emergency visit.

 

These days, data drives nearly every important decision people or organizations make. In healthcare, ICD-10 codes are just one small part of a vast sea of data that is collected and analyzed on a daily basis. But to what end?

 

Governments and NGOs around the world make use of ICD-10 codes to track global health trends. They used them to monitor the spread of communicable diseases, the prevalence of chronic conditions, and even the most common causes of death. By applying data and analytics to ICD-10 information, officials and researchers alike can maintain a better handle on global health.

 

To a clinician, an ICD-10-CM code is primarily a billing mechanism. To medical coders and billers, the codes represent tools of the trade. They are accurate descriptors for payers and valuable statistics for researchers and statisticians. The truth is that ICD-10 codes represent different things to many groups of people. They are not just numbers appearing randomly on a medical claim or a patient's medical records.