Benefits of ICD-10 By Valerie Fernandez, MBA, CPC, CPC-H, AHIMA ICD-10 Trainer he new, expanded code set of ICD-10 offers an opportunity to improve the reporting of services in all T healthcare settings. Details related to acuity, laterality, disease etiology, disease stage, and episode of care will provide information that will enable carriers to appropriately assess both the complexity and quality of care, thereby ensuring that reimbursement is consistent with the care rendered. the method for reporting asthma provides an example of acuity reporting. a determination must be made as to whether the condition is mild intermittent, mild persistent, moderate persistent, or severe persistent. once that assessment is made, additional details are required related to whether the asthma is uncomplicated, with acute exacerbation, or with status asthmaticus. severe, persistent asthma with acute exacerbation is coded as j45.51. it is the provider who must ensure the medical record supports the level of coding submitted. the attached grid demonstrates the level of documentation required to support icd-10 asthma codes. researchers will be empowered by the additional data to compile improved statistics on comorbidities, outcomes, and complications. analysis will be more efficient with regard to disease patterns and responses to public health concerns. for instance, tracking mssa and mrsa is important in the hospital setting. the icd-10 code for a methicillin-susceptible staphylococcus aureus infection is a49.01. for a methicillin-resistant staphylococcus aureus infection, the icd-10 code is a49.02. accountability of healthcare providers can be assessed based on the ability to report adverse events such as an accidental puncture of the spleen during a procedure on the spleen, d78.11. identification of a foreign body left in a body following a heart catheterization procedure, initial encounter is documented using t81.525a. such events will become part of the provider profile and will ultimately impact reimbursement and the ability to maintain participation status with insurance carriers. additionally, assessing products provided by vendors can be determined by tracking such healthcare events as a mechanical breakdown of a vascular dialysis catheter, subsequent encounter, t82.41Xd. icd-10 encompasses updated terminology and disease classifications and includes details about updated medical technology and overall advances in medicine. there is also room for expansion as new diseases are identified and developing technologies emerge. a specific example from icd-10 relates to influenza due to certain identified influenza viruses, j09.X2 novel influenza a virus with other respiratory manifestations. it is anticipated that, with the implementation of icd-10, there will be fewer inquiries from the carriers requesting notes to support medical necessity as that information will be defined within the codes submitted on the claims. healthcare costs vary by region and by hospital for the same services. currently, price does not reflect the quality of the service rendered. as healthcare reform continues across the nation, icd-10 will provide details to formalize a strategy for curbing the high cost of healthcare in the united states. a patient’s non-compliance for recommended medical treatment can be documented easily in icd-10. examples include Z91.11, patient non-compliance with dietary regimen and Z91.15, patient non-compliance with renal dialysis. taking less medication than prescribed can result in negative health consequences but may be due to financial hardship or the current mental status of the patient. Poisoning by underdosing of penicillins is coded as t36.0X6-, with the seventh digit added based on episode of care: a for initial encounter, d for subsequent encounter, and s for sequela. an additional code to indicate the reasons for underdosing should be included. examples include Z59.5 extreme poverty, Z59.6 low income, or Z59.7 insufficient social insurance and welfare support. nicotine dependence is classified as uncomplicated, in remission, or in withdrawal and is specific to the product type: cigarettes, chewing tobacco, or other tobacco product. for example, f17.213 is used for a patient who was a smoker, using cigarettes, who is now suffering from nicotine withdrawal. alcohol use, abuse, or dependence is classified with delirium, 38 hbma billing • november.december.2013
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