Don't Let the New ICD-10 Catch You Off Guard

By David Berky
CIO, Find A Code, LLC

Center for Medicare and Medicaid Services (CMS) has approved the final version for the new ICD-10-CM and ICD-10 PCS. Until coders and billers convert to this new ICD-10-CM coding system on October 1st, 2014, they will continue to use the ICD-9-CM codes and CPT/HCPCS codes. However, CMS is recommending that professionals start this new training and become well versed with these two new ICD-10 code sets.

As all coders know The ICD-9-CM code set is based on the International Classification of Diseases maintained by the WHO, the World Health Organization. These are medical codes that the medical billing professionals, doctors and nurses use to describe a specific disease, medical condition or symptoms of an illness.

There are well over 10,000 medical diagnosis codes to choose from so you can imagine how important it is to understand proper code selection processes. If a claim is submitted with incorrect coding the claim most likely will be denied causing the claim to have to be reviewed, recoded, and/or appealed. If improper code selection was made because of under trained staff or billers coding reports who are not certified coders, then the problem with the claim may never be resolved resulting in a permanent loss of those monies that should have been paid to the provider for the care given to the patient.

It is not that the physician doesn’t know how to determine when a procedure is medically necessary, but rather that the physician needs to know what the insurance company is requiring he document in the medical report to show that medical necessity was proven prior to proceeding to a surgical procedure or test.

ICD Codes are an international standard set by the WHO, the World Health Organization, a branch of the United Nations, to recognize any and all diagnoses of anyone receiving medical care of any kind anywhere in the world.

Becoming a Medical Coder

In order for a person to work as a medical billing and coding professional they must take coding classes or learn medical terminology, anatomy, disease processes, and coding methodology. Becoming certified is also a good idea and many times, when already working in the medical field, comes with a bonus or pay raise when certification is accomplished. In the past, certification was often a nice idea but not required. Many doctor’s offices encourage is often required when applying for medical coding or billing jobs and in the future will become .

Currently there are four code sets in use. The ICD-9-CM code set contains codes for diagnosis and is used by hospitals and doctors/practitioners. For recording medical procedures, injections, medical equipment, supplies and orthotics/prosthetics coders in hospitals use the third volume of the ICD-9-CM code set (volume 3, vol3 or v3). In doctors and other practitioners offices they use the combined code sets of CPT (from the AMA) and HCPCS (maintained by Medicare).

In 2014 use of the ICD-9-CM code sets (diagnosis and procedures) in hospitals will be replaced with the ICD-10-CM and the ICD-10-PCS. The first one is for all diagnoses and the second is for all procedures. Non-hospital offices and practitioners will use the ICD-10-CM code set for diagnosis, but may still choose to use the CPT/HCPCS code sets for procedures.

For years medical billing experts have used ICD-9 code set books to look up codes of diagnoses needed to bill insurance companies. In using the books there was always a margin for error, especially if the coding department did not match the diagnosis with the correct code. But, thanks to expert software, ICD-9 codes can now be easily matched with the specific diagnosis, condition, treatment and procedure for any and all illnesses, diseases, and injuries.

ICD-10 Replacing ICD-9

The ICD-9 Code set books are going to be a thing of the past come 2014 when the change from the ICD-9 codes set to the new ICD-10-CM and ICD-10-PCS code sets occurs. These two new ICD-10 coding sets consist of 10 times more codes, or over 150,000 different diagnoses and procedures.

One does not have to be a billing specialist to realize that billing departments are going to need some quality software to match these codes. ICD-10 coding will be mandatory in all hospital settings, but the CPT/HCPCS code sets can still be used in private doctor/practitioner offices. But even going from the 7,000 ICD-9-CM diagnosis codes to the 60,000+ ICD-10-CM diagnosis codes will make coding from books very difficult.

Coders and billers will have to be more familiar with the code sets, how they are organized and even brush up on anatomy and some medical terminology to truly be effective at their jobs. Given the addition of 10 times more codes, medical coding and billing departments will need to be faster and more precise and books are not going to help anymore, because it will simply take too long to research the correct codes.

ICD-10 Tools

To address these concerns several online tools such as,, have been created with quick look-up tools and integrated research and information that uses the tremendous power data linking that has made the internet such an amazing research tool. Websites such as this will greatly speed up the coding and billing process and provide much more accuracy for hospital/office coding staff.

Because medical information is updated so frequently, online data source is an ideal way to achieve just-in-time distribution of the most up-to-date medical coding and billing information. Gone are the days of paper. Electronic health records are replacing paper records.

As the old paper-based system is replaced with electronic health records, data mining will become easier and faster. ICD-10 codes, which will provider greater detail to diseases and conditions, will allow the World Health Organization (WHO) and other public organizations to for effectively track diseases and outbreaks.

Diagnoses, such as HIV and highly contagious diseases will become more easily tracked, the effectiveness of programs for vaccines and inoculations will be more readily seen, death and accidents as well as the prevalence or increase/decrease of specific diseases from one section of the country to another will be more easily tracked and monitored.

The benefits of just the change from ICD-9-CM to ICD-10-CM has yet to be realized by the healthcare industry. Right now it is such an enormous change that it tends to be a little scary to many providers. However, the ability to use a system like Find-A-Code to navigate effectively and quickly through the new codes and determine the correct code is vital and helps to relieve some of the stress related to this great change.

While the world becomes much more complex with electronic technologies, ICD coding is certainly going to need the boost of computer and internet technology to meet the challenges of ever-increasing amounts of data and the many challenges the information presents to modern healthcare.

David Berky is CIO of Find A Code, LLC. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding.

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