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The transition from ICD-9 to ICD-10 is humungous with a five times increase in diagnosis codes, to roughly 68,000 codes. Claims will not be processed if a medical practice or insurance payer does not switch to ICD-10. The new coding system does not change the procedure for outpatient billing.

ICD-10 code set can have three, four, five, six, or seven characters. Most of the three-character codes are used as headings for categories of codes; which can further expand to four, five, or six characters to add more specific details regarding the diagnosis. A three-character category that has no further subdivision can be a stand-alone. The next three characters correspond to the related etiology which is the cause of a disease or condition, anatomic site, severity, or other details. Finally, a seventh character is the most significant differences between ICD-9 and ICD-10 because the former does not provide a mechanism to track the details that the seventh character provides.

Anatomy of ICD-10 codes-

The most visible difference between ICD-9 and ICD-10 is the structure of the codes itself. The addition of codes in ICD-10 allows the reporting of increased specificity like laterality, manifestation and healing along with providing a mechanism for reporting new diseases and treatments. Over 68,000 codes will be added in the new coding system which will allow greater specificity in the documentation of diagnosis. Though this will have more benefits, it will also present transition complication for healthcare providers.

The expansive system will prove beneficial to the U.S. healthcare system to improve the tracking of data to measure the quality and safety of care, process claims for reimbursement, subsequently improving clinical, financial, and administrative performance. This switch to ICD-10 will bring to the providers:

• Enhanced operational processes by classifying detail within codes in order to accurately process payments and reimbursements

• Exhaustive information on condition, comorbidities, severity, complications and locations

• Detailed health reporting and analytics such as cost, utilization and outcome

• Extended coding flexibility, done by increasing code length to seven characters

Contact MBC for any issues related to ICD-10 code mapping, testing, implementation or denial management strategies.