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What is ICD-10?

A Primer for Healthcare Service Providers and Patients

There are new changes that have been implemented across the U.S. in regards to service, reimbursement and documentation in healthcare. Below you will find a basic explanation of ICD-10 codes, what they are and why they are used.

Medical insurance companies have a billing system that consists of codes. These codes are universal among private health insurance companies, Medicaid and Medicare. Medicaid and Medicare are government provided medical insurance services to individuals with health coverage who are too young to provide for themselves, disabled, retired persons and low income households.

Health care providers are required by medical insurance companies to justify reasons for inpatient procedures and properly code those procedures when billing for reimbursement. In order to properly charge for services, providers and health companies must use codes in billing for their services and provide documentation to be approved for payment.

These universal codes are called IDC-10 codes, updated effective October 1, 2015 from the previous ICD-9 codes. Providers and health care companies must stay up to date with these changes in billing requirements in order to ensure payment from medical insurance providers for procedures done on patients.

In fact, keeping up with changes and requirements is so time intensive, many medical offices employ medical coders, people who specifically work to properly code Medicaid billing for the doctors.

All IDC-10 codes are seven characters long, and each character is used to identify procedures, medical terms, medical devices and actions taken. All letters of the alphabet are used as well as numbers 2-9, excluding 1's and 0's so as not to be confused with the letter I or O.

This system allows for the specification of a device used in a procedure through the code. The transition from IDC-9 allows for more values to be added to classification as needed and allows more detail to be used in medical coding. This is meant to increase accuracy and ensure that only the necessary procedures are being performed. Ultimately, this is a cost saving measure, meant also to increase both efficiency and effectiveness in healthcare.

While there many guidelines, requirements and changes in these billing codes, there are also many new resources for medical providers and coding specialists. The Centers for Medicare and Medicaid (CMS) provides instructions and a guide to the changes in codes and requirements on their website along with resources to assist with any questions and contacting representatives. The CMS also offers to email updates to providers as they occur.

Learning the basics about ICD-10 is essential to understanding how, why, and what you can do to ensure that healthcare services are provided in an efficient and cost effective manner. To learn more, reach out to the schools below for more information on coding and billing courses, or to earn your certificate.

The more you know, the better prepared you will be to help disseminate high quality healthcare to people across the nation, and to prevent unnecessary treatments and charges for patients.