Understanding the Official Guidelines for ICD-10 Coding & Reporting

Healthcare Organizations ICD-10 Medical Coding Practice Management

ID 100106649 ICD-10 (International Classifications of Diseases) Coding and Reporting guidelines are provided by National Center for Health Statistics (NCHS) and Centers for Medicare and Medicaid Services (CMS) – agencies within the Department of Health and Human Services (HHS) of US Federal Government. The guidelines are aimed to be used as a guide for the official version of ICD-10-CM (Clinical Modification) to classify reasons for visits and diagnoses in health care settings and ICD-10-PCS (Procedure Coding System) which relates to in-patient hospitals only.

ICD-10 is different from ICD-9

In short, ICD-10 will affect all areas of the industry which includes billing, staff training, claims submission and resource management. It must be mentioned here that, solely alphanumeric ICD-10 is not just an update of ICD-9 – there are differences in the fundamental changes of concepts and structure. Health Information Services (HIS) can guide your company and help understand the official guidelines and complexities for ICD-10 coding and reporting, thus making the transformation smooth.

A closer look at the guidelines

The guidelines are a set of rules developed to complement and accompany the official conventions provided in ICD-10-CM. Based on sequencing instructions and coding in the Alphabetic Index and Tabular List, one needs to adhere to the guidelines and  diagnoses codes under the regulation of Health Insurance Portability and Accountability Act or HIPAA. Aimed to achieve accurate and complete documentation, procedures, reporting of diagnoses and code assignments, ICD-10 has been developed to help both coder and healthcare provider to identify the diagnoses to be reported.

Structure and Format of ICD-10 coding and reporting with the help of Healthcare Information Services

The tabular list has categories, sub-categories and codes that are alphanumeric. The categories are all of 3 characters, the subcategories are of 4/5 characters and the codes are of 3/4/5/6/7 characters. The codes are used solely for reporting purposes. The 7th character extension (qualifier) represents sequelae for external causes of injuries, obstetrics and visit encounter and is completely different from ICD-9 CM format.

There is also a placeholder character ‘X’ that can be used for certain codes to allow any future expansion. There are also uses of abbreviations in Alphabetic Index Abbreviation and Tabular list abbreviation like NEC- not elsewhere classifiable, which represents ‘other specified’ and NOS- not otherwise specified. However, to process ICD-10 claims and transactions, vendors, providers and payers must implement ‘Version 5010’ electronic healthcare transactions standards that have been mandated by HIPAA.

Simplified ICD-10 coding and reporting at a glance

The 3 distinct sections of the guidelines are:

  1. Conventions
  2. Medical/Surgical sections – this remains the most extensive of all the sections that deals with body system, body part, root operation, approach and device.
  3. Obstetrics section

Quite a few terms used in ICD-10 are defined right within the system. It depends on the coder to determine what the documentations in the medical records will equate to in the PCS definitions. All codes in the PCS are of 7 characters and the letters O and I and not used, though the numbers 0 and 1 are used. Additionally, each character has a meaning which changes by sections.

Implementing ICD-10 Coding and Reporting

A serious headache for healthcare providers, it will affect all vital areas of the industry and is best implemented by taking help of a professional service provider. Healthcare Information Services (HIS) can offer your company the best possible guidance through the complex procedures of ICD-10. HIS is extremely well-equipped to deal with all aspects of ICD-10, including denial management and claims that are quite common during any major industry shift. Department of Health and Human Service will issue an order requiring healthcare providers to adopt ICD-10 procedure codes and diagnosis before October 1, 2013.