ICD-10 Code Transition Analysis

A Comparative Analysis Of ICD-10-CM (PCS)
There are a lot of difference in the structural between ICD–10–CM/PCS. The ICD–9–CM is the
international classification of Diseases,9th Revision Clinical Modification it's been used in the
United States since 1979 to code diagnoses that describe patients reasons for seeking health care
services and to code inpatient hospital services. Did you know that ICD–9–CM will be a legacy
system only use for historical purposes because ICD–10–CM and ICD–10–PCS become mandated
code sets for transactions conducted by covered entities under the Hipaa. ICD–9–CM emphasizes
the intent of the modification to classify and manage data related to the actual examination and
treatment of patients. But using ICD–9–CM to code medical claims for reimbursement, ICD–9–CM
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The difference between theses two medical coding systems that medical practices rely on being
financial stability.ICD–9 contains approximately 13,000 codes and ICD–10 will contain a totally
68,000 available codes. The ICD–10 structure code is greatly expanded and the new codes are
capable of reporting data in much greater specific. When the CMS mandated the changes to be
effective in 2014. The data ICD–10 codes contain is expected to improve the efficiency of
healthcare reimbursement and reduce charges of fraud and abuse. The ICD–10 billing will involve
an all encompassing alphanumeric systemization. The ICD–10 diagnosis code will always be a letter
then numbers. The ICD–10CM/PCS has two consisted parts, ICD–10–CM diagnosed classification
system developed by the centers for disease control and prevention for use in all U.S. health care
treatment settings. Diagnosis coding under this system uses 3–7 alpha and numeric digit and full
code titles. ICD–9–cm is very much the same. ICD–10–PCS procedure classification system
developed by the centers for Medicare and Medicaid services CMS for use in the U.S. for inpatient
hospital setting only. The new procedure coding system uses 7 alpha or numerical digits while the
ICD–9–cm coding system uses 3or4 numbers that's the
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Healthcare Common Procedure Coding System
Clinical vocabularies are defined as terminologies or coding systems that are structured list of terms
which together with their definitions are designed to describe unambiguously the care and treatment
of patients. The clinical vocabularies are used to create classification systems that are used around
the world to provide a method of distributing coded concepts in a stored meaningful manner.
(Thomson 2013) 1. What vocabularies do you have to choose from? The week 4 Neehr Perfect
Assignment gives a list of the more well known and most commonly used classification systems and
are as followed: Healthcare Common Procedure Coding System (HCPCS) Healthcare Common
Procedure Coding System (HCPCS) Level II International Classification of Diseases, ... Show more
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International Classification of Diseases, 10th revision, Procedure Coding System (ICD–10–PCS):
Coding system developed to replace Volume 3 of the ICD–9–CM manual. International
Classification of Diseases for Oncology (ICD–O): Coding system used in tumor or cancer registries
for coding the site (topography) and the histology (morphology) of neoplasms. National Drug Codes
(NDC): Universal product identifier for human drugs used to identify and report drug products.
Current Procedural Terminology (CPT): Coding system established by the American Medical
Association for coding of procedures and services. Diagnostic and statistical manual of Mental
disorders (DSM): Standard classification of mental disorders used by mental health professionals in
the US. Logical Observation Identifiers Names and Codes (LOINC): A free, universal standard for
laboratory and clinical observations, and to enable exchange of health information across different
systems. 3. Is the vocabulary appropriate for your setting and

Tenth Revision
The International Classification of Diseases, Tenth Revision (ICD–10) has been in development
since 1983 to replace the outdated Ninth Revision (ICD–9) that has been in use in the U.S. for over
35 years (Giannangelo, 2015). Due to the Health Insurance Portability and Accountability Act
(HIPAA) Administrative Simplification regulation published in 2009, the Clinical Modification
(ICD–10–CM) will replace ICD–9–CM Volumes 1 and 2, and the Procedure Coding System (ICD–
10–PCS) will replace ICD–9–CM Volume 3 for all HIPAA transactions effective October 2015
(Giannangelo, 2015). These new code sets accommodate new procedures and diagnoses and allow
for greater specificity in clinical documentation (Centers for Medicare & Medicaid Services [CMS],
Mapping guidelines, or mapping decisions, detail how to select the best code translation in order to
ensure clinical semantic interoperability, as well as limiting the impact to organizational operations,
such as administrative and financial functionality. Additionally, these guidelines outline the ways in
which mapping rules should comply with or override GEMs. As previously stated, GEMs should be
utilized as a guide, not a stringent directive, to aid in code conversion. Therefore, mappings
identified by the GEMs can either be accepted, overridden by selecting a different approximate
match or combination code, overridden by selecting target codes from a different GEM option, or
overridden by rejecting all GEM suggestions and selecting or creating a new mapping not listed
(De, 2012). All mapping selections must be agreed upon by the mapping team; therefore, all
individual mappings need to include justification for the codes selected in order to aid in
interpretation during review (De,

Medical Billing And Coding Industry
The Medical Billing and Coding industry is ever changing. In order to keep up with the trends you
always need to be learning and keep on your toes. With the transition to ICD–10, Implementation of
The Affordable care act, and computer–assisted coding it is necessary to be forward thinking at all
times! ICD–10 is "The International Classification of Diseases, Tenth Revision, Clinical
Modification (ICD–10–CM) is a system used by physicians and other healthcare providers to
classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital
care in the United States (Rouse, n.d.). ICD–10 replaced the hard to understand ICD–9. ICD–10 is
now used to help prevent, fraudulent charges, wrongful coding, and it

What Are The Standardized Code Sets?
HIPAA as we have all learned by now stands for the Health Insurance Portability and Accountability
Act. HIPAA mandates providers and contractors to use approved standardized code sets so as to
ensure the ebb and flow of our health care system can continue to improve and become more
efficient. Let's look at it another way. You have hundreds of thousands of medical facilities all
coding their bills. Imagine if they all did things differently and all used different code sets how
much harder it would be for insurance companies to pay out in a timely manner.
When HIPAA became enacted in 1996, they set standards for how electronic billing should be
handled within covered entities (a covered entity as we should all know are health plans, ... Show
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The structural base for them are not quite the same. The setup for the manual, the formatting of
codes and even some of the guidelines are different (not to mention ICD–10–CM has around 70,000
codes while ICD–9–CM has only about 16,000 codes).
ICD–9–CM contained procedural codes in volume 3, ICD–10–CM does not contain any as they are
now implemented within ICD–10–PCS.
ICD–9–CM procedure codes had about 3,000 codes, ICD–10–PCS has over 72,000 codes. The way
the new system has been set up this number has the ability to grow as well.
ICD–9–CM diagnosis codes were 3 to 5 characters in length, ICD–10–CM codes are 3 to 7
characters in length.
ICD–9–CM codes are the majority numbers only with the exception of those supplemental V and E
codes, ICD–10–CM codes are all alphanumeric.
Remember, ICD–9–CM was implemented and in use since 1979, so updating terminology and new
classifications were also changed with the upgrade of ICD–10–CM/PCS.
ICD–9–CM codes could before be labeled in just one code, now with more clinical detail to sort
through, ICD–10–CM have many more codes to choose from that are much more detail oriented and
specific.
I'm actually really excited to be starting this month's course and learn the ICD coding process. I am
nearing the end of my college experience soon and will be beginning my externship after next

month's course. When I am done I will graduate with a certificate in Medical billing and coding. I
will be

Essay on Converting from Icd 9 to Icd 10
Converting from ICD 9 to ICD 10
Kaplan University
Unit 9 Final Project
CM107
Converting from ICD 9 to ICD10
I. Introduction a. Why converting to ICD 10 is important b. What do we need to do to prepare for
the transition? II. ICD 10 will affect a lot of people a. It affects providers when diagnosing a patient
b. It affects the coders by having to learn a new system III. What you can do to ease the transition a.
Upgrade electronic medical record systems b. Upgrade practice management systems c. Update
encounter form with most used codes
IV. Conclusion a. It is important to make the transition because
The International Classification ... Show more content on Helpwriting.net ...
We also need to have our systems upgraded with the correct software. Staff must be aware that the
old and new ICD will have to co–exist while the system is reengineered. We must review all of our
processes, systems, and reports to find out where icd–9 codes are presently being used. That will
make sure that no one is left out once the upgrade takes effect. The transition to ICD–10 gives us an
opportunity to focus on our processes. This may also help to ease the transition to ICD–10. The
change to the new system will affect many staff members in our clinic. Physicians should find it
easier to diagnose patients since this coding set is more specific than the previous one. For instance
when previously diagnosing asthma you had 2 choices, intrinsic and extrinsic. With this new set of
codes the provider can choose from mild intermittent, mild persistent, and moderate persistent just
to name a few. There is a broader range for the providers to select which will make it easier on
them. Since there will be more documentation, providers will have to ensure they keep up so as not
to get behind. The coders will have to learn 5 times as many sets of codes. They will also have to be
re–certified to use ICD10 (AHIMA 03). We

Influence On The Workplace Settings
Influence On The Workplace Settings
ICD–10–CM/PCS touches on almost every aspect of healthcare systems and processes. Patient
access is impacted by ICD–10–CM/PCS in regards to information capture, registration, and medical
necessity. The influence on clinical care is with disease and case management, DRG assignment and
case mix management, clinical documentation and coding, care guidelines or protocols, and nursing
documentation. Billing and financial systems are also affecting for health plan contracting, coding,
claims processing, payment policy, and physician reimbursement management. Health information
systems impacted include; clinical documentation and coding; electronic health record and CPOE;
e–Rx pharmacy and radiology systems; and health exchange integration and support processes.
Performance and reporting areas influenced by ICD–10 include: clinical research and registry
reporting; performance measurement; audits and fraud and abuse investigation support; quality
measures and pay–for–performance; epidemiology and public health reporting.
The healthcare industry in general will benefit from having more robust data surrounding diagnoses
and procedures for measuring the quality and value of care. It should ultimately improve assessment
of patient outcomes. The new ICD–10–CM/PCS codes are anticipated to be multifaceted with deep
impacts on systems, processes, and people.
New and improved codes. External cause of injury codes are much more detailed in

ICD-10-CM: A Case Study
CD–10–CM has a greater number of new features that allow a greater level of specificity and
clinical detail such as combination codes for conditions and symptoms or common manifestations,
Codes of combination for poisoning and external causes, extensions were added for the episode of
attention among others. Some of the changes are: Coding procedure changes – As providers and
coders make the transition to ICD–10–CM, their documentation/coding workflows will change. If
coder is using ICD–10 code lookup tool to assist with the code conversion, they'll need to update
procedures to reflect the new step. Coding rejection auditing – Billers might be responsible for
auditing the use of ICD–10 codes and any rejections received by payers as a result

Quality Of Care Case Study
Another major issue that affects the quality of care is the implementation of new coding systems
under the International Classification of Diseases by the United States government. In order to
further understand the affects of these coding systems, we first should look at how they actually
work. The current coding system being used nationwide, ICD–9, works as a way of identifying
certain medical procedures and making sure that these medical procedures match the diagnosis. For
instance, Dr. Karen Malley, a podiatrist, sees an average of twenty patients a day. Due to the
limitations of her license, she can only do procedures that relate to that of the foot, therefore, she has
a relatively small number of diagnosis codes that she has to learn ... Show more content on
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What normally would take approximately thirty seconds to a minute to identify, now takes up to
three to four minutes. Because most medical doctors are already trying to see as many patients as
they can to compensate for the previously mentioned Affordable Care Act, they only have a set
number of minutes dedicated to each type of patient. This time between the patient and doctor is
crucial, and as a result of its decrease we can expect to see a decrease in the quality of care that each
patient is then able to receive. The reason for the implementation of this new coding system is
because of the United States government's need to conform. They want to conform to the
international coding systems that are already in affect by many other major countries in order to
make a more universal system of health care. However, many doctors have asked why? Why does
the government need to conform to this universal system, and more importantly, why do they need
to know such specificity of medical

Icd 10 Essay
On October 1st, 2015 ICD–10 (International Classification of Disease) code was set up to take place
of ICD–9 codes. It has actually been in the works for several years to make the change. The Change
is being required by the Center for Medicare and Medicaid services to provide more specificity to
the existing coding system. The ICD–10 uses up to five times as many codes as the former codes of
ICD–9 set. This will require more documentation, revised forms, retraining of staff, physicians, and
changes in the software. This could require up to sixteen hours of training for coding staff.
Structural difference between ICD–9 and ICD–10 are ICD–9 used mainly numeric digits, and ICD–
10 is using alpha and numeric digits. Medical providers had to be ready for a conversion of the new
codes which could have to the potential for 140,000 new codes to bill the government and private
insurers. . Step 3– This issue with the change has not currently affected me since I have yet to work
in the field or attend more core classes. I have spoke with a lady I know in the field, and she had let
me know the changes are big. They are affecting her workplace by requiring additional training, but
can make things easier by having less contacting the ... Show more content on Helpwriting.net ...
It seems to always take a little bit of time to get into the swing of how to do it the new way, and
once everyone comes around they may find that ICD–10 is better to use than ICD–9. The structural
differences between the two code systems are that ICD–9 had three to five digits mostly numeric
and ICD–10 has three to seven with an alpha first digit, numeric second, alpha third through the
seventh digit. It would seem that thought of more characters is what is scaring more people than
actually putting the ICD–10 to use. The actual effect of these changes really won't be clearly known
until the system is in full effect and claims processing

Classification Of Diseases
International Classification of Diseases
The adoption of Electronic Health Record (EHR) system promises a number of substantial benefits
including better care and decreased health care costs. One of them is the International Classification
of Diseases (ICD). These International Classification of Disease (ICD) is developed by the World
Health Organization, which has a set of diagnostic codes for the classification of disease, mortality
and morbidity, indexing hospital records by disease, analyzing payments, resource utilization and
tracking public health records (Hebda & Czar, 2013). There are two classification systems, the ICD–
9 which is used by the United States for reimbursement purposes and the ICD–10 is used
internationally. Currently, ... Show more content on Helpwriting.net ...
The conversion to ICD–10 CM/PCS may present challenges initially, but will offer substantial
benefits to the APRNs over time. The ICD–9 is developed based on the health landscape 34 years
ago, uses outdated technology, lack details, uses antiquated terminology and lacks optimal claim
reimbursement whereas, ICD–10 provides a much needed update to medical terminology and
disease classification. In addition, ICD–10 will allow APRN to better evaluate patient care, support
research initiatives, construct payment systems, process claim, make clinical decisions, observe
public health trends, and uncover fraud. Therefore, ICD–10 classification system will support the
Advance Practice Nurse more than than the ICD–9 classification

The American Medical Association ( Ama )
First, Do No Harm: Implement ICD 10 Now
The American Medical Association (AMA) pushes to continue delaying implementation of ICD10.
In 1975, The International Conference for the Ninth Revision of the International Classification
Diseases, was convened by the World Health Organization (WHO), in Geneva. During discussions
that lead up to the conference, the original intent was that there should be little change, other than
some updating of classifications. This was mainly due to the expense of adopting data processing
systems each time the classification was revised.
A number of nations had become interested in using the ICD for statistical modeling and there was
concern that the subject areas were incorrectly organized and pressure was put on the committee for
greater detail in the coding classes. Additionally, there was a growing need for adoption and a way
to enable the classifications that were more relevant for the evaluation and treatment of patients.
Forward 20 years
The ICD–10 coding model was endorsed by the WHO in May 1990 and came into use by member
States beginning in 1994. Now ICD is currently under revision again, through the WHO Revision
Process, with the release date for ICD–11 set for 2017.1
While every developed country has adopted the ICD–10, with the first country doing so on July 1st
1998. The United States has yet to adopt.
A few short years ago
One factor, preventing the United States' implementation ICD–10, was the implementation of EDI
Version

Classification Of Information For The Healthcare System
Overview of coding Coding consists of ICD–9–CM, ICD–10–CM, CPT and HCPCS codes. The
codes help classify and document the information for the healthcare system in the United States.
The ICD–9–CM stands for the International Classification of Diseases, Clinical Modifications.
October 1st 2014 ICD–10–CM came out to update the class with more illnesses, conditions, and
injuries of any patient that used the medical services. The ICD–9–CM is generally classified as
numerical and alphanumerical codes with codes describing the illness and injuries. The CPT which
is Current Procedural Terminology and the HCPCS which is the Healthcare Common Procedure
Coding System are used in various medical settings. The CPT is published by the AMA yearly. CPT
The CPT code book has nine different conventions including with symbols in the book. The
semicolon identify the main entry what is it part of all indented entries that follow with their code.
The bullets and triangles identify as the changes that were made and the current code. The facing
triangle symbol is used to identify the beginning and ending of a new or revised text within the
guidelines and instruction notes. Plus symbols are you when a procedure is carried out with another
procedure. Circled bullet symbols indicate moderate sedation is inherits part of the procedure. The
null symbol indicates codes that may not be appended with modifier 51. The pending symbol
indicates for a vaccine that is pending approval from the FDA. The resequenced symbol do not
appear in numeric sequence the reinstated code applies to codes that have been recycled. Some of
the general rules for CPT coding are analyze the note or procedural statement, determine the
procedure, locate the main term in the index, review and select the sub terms, note the code numbers
if found opposite of the selected terms, if applicable follow cross–reference never code directly
from the index, read all the notes that apply to the code, select the appropriate modifier, continue
coding all components of the procedure or services. Modifiers Modifiers may be reported with a
CPT code to identify a particular service or

Icd 10 Diagnostic Code
Before discussing the implementation process of ICD–10 it is imperative to understand the
differences between ICD–9 and ICD–10 coding and the reason for the transition. The new ICD–10
coding has over 69,000 codes to identify diagnoses compared to 14,000 in the ICD–9 coding
version. The increasing number of codes will aid in specificity of all diagnoses. Every diagnosis has
a specific code identity. The code identity for the ICD–10 coding is made up of seven digits whereas
ICD–9 coding has only three to five digits for each diagnosis. These digits are numbers used to
explain a specific injury or procedure. Behind each diagnostic code is an exclusion wording. It gives
the diagnosis code in specific detail of the exact diagnosis the physician

Diagnostic Coding And Procedural Coding
Medical Coding Essay Academic Essay Diagnostic coding and procedural coding lend themselves
well to the improvement of healthcare efficiency. Both have accurate recording for diagnoses and
the procedures enable the analysis of information for the patient's care, research, performance
improvement, healthcare planning and facility management. The diagnosis codes are divided into
chapters, sections, subsections, and subcategories (1). A coder should become familiar with all of
the codes before the individual moves on. It is very important to understand when an additional
code or codes are needed, what codes are secondary, and when additional information may be
needed to complete the code (1). Also, the coder should always code the reason why the patient
sought medical advice as the main diagnosis (1). There are many rules when using diagnostic and
procedural codes. By using the national diagnostic and procedural coding system correctly the coder
will have no trouble on finding the right codes to use for the case scenarios.
The information the coder needs to get from the health records is very important because this will
provide the correct information on the claim when it is billed out. If the steps are not followed
correctly then the information being submitted will not be correct. Here are the steps that need to be
taken to find the proper sequencing when diagnosing and coding are the coder needs to find the
main term or terms in the patient's medical records.

ICD-9-CM Analysis
ICD–9–CM is the United States' alteration of the International Classification of Diseases, Ninth
Revision, created by the World Health Organization. It is the most generally connected arrangement
framework for coding analyze, explanations behind social insurance experiences, wellbeing status,
and outside reasons for damage. The controls with respect to electronic exchanges and code set
declared under HIPAA assign ICD–9–CM as the medicinal code set standard for sicknesses,
wounds, or different experiences for social insurance administrations. In declaration before
Congress in May 2002, Sue Prophet, AHIMA's executive of coding arrangement and consistency,
affirmed that "AHIMA trusts that appropriation of a substitution for the ICD–9–CM analysis ...
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These progressions ought to bring about real enhancements in both the quality and employments of
information for different medicinal services settings. Huge enhancements in both the substance and
the organization of ICD–10–CM incorporate the accompanying:
General Changes and Overall Improvements
ICD–10–CM codes are alphanumeric and incorporate all letters aside from "U," along these lines
giving a more noteworthy pool of code numbers. ICD–9–CM's V and E codes are joined into the
fundamental grouping in ICD–10–CM. The length of codes in ICD–10–CM can be a greatest of
seven characters (digits and letters) instead of ICD–9–CM's five digits. ICD–10–CM offers the
expansion of data with respect to mobile and oversaw mind experiences.
Conditions that are new or that were not interestingly distinguished in ICD–9–CM have been
allowed code numbers in

Hospital Wage Rate Differences
Due to the advances in technology, medical practitioners are more able to retrieve medical
information. Coding systems, such as ICD–10–CM, CPT, and HCPCS are used to code and enter
such information into a database. These coding systems are useful in administrative and statistical
purposes. The Center for Medicare & Medicaid Services, CMS uses a prospective payment services,
which was effected in 2012 and 2013 to ensure better health care at lower costs (CMS, 2015).
The CMS payment system standardizes bills to enhance comparability by adjusting charges to
eliminate hospital wage rate differences. Under the payment system facilities receive a single
payment per Medicare beneficiary to provide for a full inpatient stay or a defined time period.

HIPAA Transaction And Code Set Standards
HIPPA Transaction and Code Set Standards apply to the electronic exchange of information between
two parties for a specific purpose. HIPPA adopted standards for electronic information, transactions
of administrative healthcare data between health care providers, and health care facilities. If a
healthcare organization or provider uses one of the designated health care electronic transaction
code sets. HIPPA requires that the healthcare professional or organization must adhere and adopt the
content and format requirements of each transaction to follow HIPPA Transaction and Code Set
Standards by October 1, 2015. HIPPA Transactional Code Set Standards adopted HHS version X12
and Version 5010 and version D.0 for HIPPA transactions. By adopting

Application Of Computer Assisted Coding
The trends one can find when reading through the articles found under the AHIMA Body of
Knowledge pertaining to the coding function is relative to the use of computer–assisted coding,
implementation of Electronic Health Record (HER), and the transition to ICD–10–CM. Computer–
assisted coding is defined as the "use of computer software that automatically generates a set of
medical codes for review, validation, and use based upon clinical documentation provided by
healthcare practitioners" The outmoded coding professional's role was to describe and apportion
diagnosis, procedure, and other medicinal service codes using ICD–9–CM and HCPCS/CPT coding
classifications while referencing the Coding Clinic for ICD–9–CM, Coding Clinic for HCPCS, ...
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These codes are then reviewed by a human coder." There are several advantages that computer–
assisted coding offers with its strategy over manual coding, including increased productivity and
accuracy, enhanced efficiency, and advance compliance in coding and the consistent use of coding
rules. By no means does computer–assisted coding replace the human coder. There is an
accentuation on the need for quality of coded data with the use of computer–assisted coding in
healthcare organizations to assure compliance is being met with regards to the increasingly
multifaceted quality reporting requirements. "Data is plural of datum, which is the dates, numbers,
ages, symbols, letters, and words that represent basic facts and observations about people, processes,
measurements, and conditions." To be useful, data must be accurate. Once data is collected it can be
used by numerous health care providers and decision makers to monitor the health and needs of
individuals and populations, as well as contribute to the analysis of the health system. Users
including hospitals, health care practitioners, government, professional associations, researchers,
media, students, and the general public. Having the correct and up–to–date coded data is critical, not
only for the delivery of high–quality clinical care, but also for continuing health care, maintaining
health care at an optimum level, for clinical and health service research, and planning and
management of

Icd 9 In Healthcare
The Centers for Medicare and Medicaid Services (CMS) requires all providers to implement ICD–
10 coding system begin on October 1st, 2015 so the U.S. healthcare system can communicate in the
same language as with other countries' systems. The transition from ICD–9 to ICD–10 had big
changes from 14,000 diagnostic codes to more than 68,000 and 4,000 procedure codes to 87,000.
The transition affected the reimbursements of hospitals. Medicare requires all patients' procedures
and services to be coded using ICD–10 system while they are charged in CDM using CPT codes.
However, there is no direct link between ICD and CPT codes (Jensen, Ward, & Starbuck, 2016).
The CDM committee had to work together to prepare for this event. Switching from numerical

The Change from ICD-9-MCS to ICD-10-CMS
The change from:
ICD–9–CMS to ICD–10–CMS
Due to ICD–9–CMS' ability to provide necessary detail for patients' medical conditions or the
procedures and services performed on hospital patients, ICD–10–CM/PCS was implemented.
Problems with ICD–9–CMS were:
Program over 30 years old
Outdated and obsolete terminology
Uses outdated codes that produce inaccurate and limited data
Inconsistent with current medical practice
The implementation of the new ICD–10CM/PC will:
Enhance accurate payment for services rendered
Facilitate evaluation of medical processes and outcomes
A number of countries have already moved to ICD–10–CM, but here in the United States we are
still behind, and have not evolved from ICD–9–CM to ICD–10–CM.
The compliance date for implementation of the International Classification of Diseases, 10th
Edition, Clinical Modification/Procedure Coding System (ICD–10–CM/PCS) was October 1, 2013
for all covered entities. Although, a number of countries that have already converted to ICD–10:
➤ United Kingdom (1995)
➤ France (1997)
➤ Australia (1998)
➤ Germany (2000)
➤ Canada (2001)
ICD–10–CM/PCS consists of two parts:
Subtle differences include:
➤ Diagnosis classification system developed by the Centers for Disease Control and Prevention for
use in all U.S. health care treatment settings. Diagnosis coding under this system uses 3–7 alpha and
numeric digits and full code titles, but the format is very much the same as ICD–9–CM
More

The Importance Of The HIPAA Interactions And Code Set...
The HIPAA transactions and code set standards are certain rules that regulate electronic data
interchange (EDI) of healthcare information, which include patients' identifiable and medical data,
between two or more parties. Under the Health Insurance Portability and Accountability Act of 1996
(HIPAA), if providers or healthcare organizations conduct one of the nine types of electronic
transactions of health–related information, they must adhere to the standards, which include claims
status reporting, claims submission, referral authorization and certification, and benefits
coordination. In addition, HIPAA mandates that all transactions must use standardized medical code
sets, such as CPT codes, Health Care Procedure Coding System (HCPCS), and ICD–10, to ensure
the uniform communications between providers, healthcare organizations, and payers ( American
Medical Association, 2013).
The standards affect all practices because insurance payers and health plans require all paper or
electronically submitted claims must use HIPAA transactions and code set standards to be complied
with HIPAA rules and regulations. The Code Set standards allows any insurance companies to
understand the provided services that providers send in submitted claims. Therefore, the HIPAA
standards assure that payers will promptly respond to electronic claims submission with proper
reimbursements for providers and healthcare organizations with minimal delays. With electronic
transactions, the standards have

Case Study : Lesson 9 Exercise 1
Lesson 9 exercise 1: The information that should be obtained from the patient at the time of
scheduling the appointment is the reason for the visit, name, DOB, phone number, and insurance
information. It is important for the medical assistant to verify whether the office is a preferred
provider with the patient's insurance at the time the appointment is scheduled to alleviate any
confusion or misunderstanding, and so the patient can make the choice to find another provider that
accepts their insurance. The policy states that if a patient has a copay or any other payment that
needs to be made then he/she should do so at the time of their visit. This is usually done at the end
of the visit encase the doctor orders any tests or lab work that might cost the patient more money.
Patient's should be informed of all or any charges and given an estimated cost. Kristin was correct in
stating that Mountain View Clinic was not a participating provider for Shaunti's insurance plan. This
was the family was aware of needing to pay for the visit and with the estimate that Kristin offered
they had an idea of how much the appointment was going to cost prior to seeing the doctor. The
medical assistant should have advised Shaunti's mother to call back with the insurance information
and/or gave her a list of what insurance companies Mountain View Clinic accepted. This would
have alleviated the confusion during Shaunti's check in with Kristin and would have allowed the
parents to find a

ICD-10 Codes
I am choosing ICD–10 Codes. The reason I have chosen ICD–10 codes is because every medical
facility uses the ICD–10 codes for the billing and coding. That is the only way they get paid is by
using ICD–10 codes. They will all receive adequate payments using the updated codes and the right
type of billing.
Step 2 & 3:
The interested parties I have chosen are: Dental Offices, Physician Offices and Hospitals.
All three of the parties have an interest in ICD–10 codes. They all have to use the updated version of
ICD–10 codes, for the fact, it is an medical guideline by the government. The ICD–10 codes are
easier to use than writing out the full medical term. They have over ten thousand codes, they can
range from weird codes to normal

Healthcare Revolution : Coding Around Us-The Breakdown Of 3M
Healthcare Revolution: Coding Around Us– The Breakdown of 3M Introduction: In the daily
changes of healthcare, health information technology is evolving rapidly. The generation of coding
is making significant developments along the years as well. The 3M–encoder system provides
number of essential options to coders in just one click. It provides sophisticated, easy–to–learn
solution for accurate, complete, and compliant coding and grouping. Coders need to be acquainted
with these references because they provide back up through the articles in each one of them. 3M
Coding and Reimbursement System, 3M Coding Reference, and 3M Coding Reference plus have
articles for coders to read and get answers to use the appropriate codes. (Prophet). Due ... Show
more content on Helpwriting.net ...
The Clinical Pharmacology Drug Reference provides diagnoses followed by a link to provide more
assistant related to the age. The number four feature shows 4 ways Nasal and a link to follow for
Adult Monograph and another one to View Pediatric Monograph. Under the references comes the
3M Coding Reference Plus, and it contains AHA Coding Clinic for HCPCS, Coders' Desk
Reference for Procedures by Optum, Anesthesia Crosswalk, Faye Brown's ICD–9–CM Coding
Handbook, and ICD–10–CM and ICD–10–PCS Coding Handbook. The References include
introductions, changes in the ICD coding, and guidelines for coders to find and better understand the
coding process. For example, the Anesthesia section provides the section of the surgery and next to
it the section where the right code can be assigned. Then, the Coding Clinic for HCPCS provide
some articles and questions with their answers related to coding and the changes to some codes.
These references are crucial in the coding sector, especially with the changes that occur on some
codes and modifiers. Coders should be aware of the references and use them to avoid intention and
non–intention mistakes, frauds or abuse. The AHA Coding Clinic and AMAAssistant provide vital
features for coders to prevent code fraud and abuse. The features can be found in the tabs of each
assistant window. For example, the

Icd Data Collection Case Study
The original function for ICD data collection was for statistics and research while ICD–10–CM has
many differences from ICD–9–CM; the new classification system does retain the traditional format
and many of the same characteristics and conventions (AHIMA's 75th Anniversary National
Convention and Exhibit Proceedings, 2003). Creating a data integration plan for Green Tree
Healthcare starts with should be a unique code for all substantially different procedures.
According, to The Centers for Medicare & Medicaid Services (CMS) the goal is to establish a
unique code for all substantially different procedures:
Completeness– There should be a unique code for all substantially different procedures.
Expandability– As new procedures are developed, the structure ... Show more content on
Helpwriting.net ...
(2003, October). ICD–9 CM to ICD–10 CM: Implementation Issues and Challenges. Retrieved from
http://library.ahima.org/doc
Averill, Richard F. (1996). The Development of the ICD–10 procedure coding system (ICD–10–
PCS): Draft. Wallingford, CT: 3M Health Information System.
Centers for Medicare and Medicaid Services. (n.d.). Development of the ICD–10 Procedure Coding
System (ICD–10–PCS) [PDF]. Retrieved from
https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2015–pcs–final–report.pdf
Centers for Medicare & Medicaid Services (CMS). (February 24). Lessons Learned: Reflections on
CMS and the Successful Implementation of ICD–10 | The CMS Blog. Retrieved from
https://blog.cms.gov/2016/02/24/lessons–learned–reflections–on–cms–and–the–successful–
implementation–of–icd–10/
Ormondroyd, T. (2013, July 17). How ICD–10 will benefit physicians | Medical Practice Insider.
Retrieved from http://www.medicalpracticeinsider.com/best–practices/compliance/how–icd–10–
will–benefit–physicians
Wiskerchen, MBA, CPC, S. (n.d.). Mapping Your Way to ICD–10 Implementation Success.
Retrieved from

History Of Icd 10 Cm : Coding And Billing
The History of ICD–10–CM Coding & Billing I HIMS 2420 January 11, 2015 Sandi Brennan Chris
Michener, Instructor Health care is growing and demand on our health care system is rising.
According to the Administration on Aging of the U.S. Department of Health and Human Services,
people 65+ represented roughly 13% of the population in 2011, but are expected to be 21% of the
population by 2040. The aging population, as well as increasing technological advances, and
improved access to health care reinforce why reimbursement optimization is now essential to cost
control and maintaining the quality of our health care system. Coding systems are used in the
inpatient and outpatient settings for the classification of patient morbidity and mortality information
for statistical use. The World Health Organization (WHO) developed the Ninth Revision,
International Classification of Diseases (ICD–9) in the 1970s to track mortality statistics across the
world. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–
CM), is the adaptation the U.S. health system uses as a standard list of six–character alphanumeric
codes to describe diagnoses. Globally utilizing a standardized system improves consistency in
recording symptoms and diagnoses for payer claims reimbursement, as well as clinical research, and
tracking purposes. Almost all countries in the world now utilize ICD–10 released by WHO in 1993,
which is more detailed and data–rich,

ICD-9-CM Coding Classification System
Similar to the previous study, the ICD–9–CM coding classification system was used for case
definition of CT and NG cases. A male or female service member of the US Army with a first–time
diagnosis (incidence case) of CT infection based on the ICD–9–CM codes 099.41 or 099.5, or with
NG infection based on the ICD–9–CM codes 098.0x, 098.1x, 098.4x, or 098.8x) in either the first or
second diagnostic position of a record of an outpatient or inpatient encounter of a medical record
between January 1, 2006 and December 31, 2012 were initially selected. For both CT and NG case,
the index date was the date of diagnosis of infection registered in the DMSS. Consequently, medical
records (inpatient and outpatient) from all incident CT or NG cases selected ... Show more content
on Helpwriting.net ...
For both bacterial infections, some researchers recommend that to eliminate persistent infections, it
should use a laboratory test after the first infection before estimating the number of repeat
infections. In contrast, other researchers consider that the infected patient should be asymptomatic
for at least two weeks before counting as a new infection. However, the majority of researchers set a
number of days after the initial infection to determine the burden of repeat infections (Hillis et al.,
1994; Richey et al., 1999; Barnett and Brundage, 2001; Burstein et al., 2001). The most common
time frame for consideration as a repeat infection for CT and NG is that diagnosed 30 days or more
after the preceding infection. This minimal time interval is based on the evidence that nucleic acid
amplification tests may occasionally detect residual chlamydia deoxyribonucleic acid or ribonucleic
acid to three weeks after antimicrobial therapy (Workowski et al., 1996; Gaydos et al., 1998; Morre
et al., 1998; Xu et al., 2000). For this study and data analysis, all service members with more than
one CT or NG report registered in the DMSS, a subsequent diagnosis of infection must occur at
least 30 or more days from the

ICD-10 Summary
Although implementation of ICD–10 adoption by other countries started in the 1990s, the US was
hesitant with adopting a new system, ultimately affecting many businesses' efficiency. Cost was the
biggest concern, with implementation comes training, errors and upkeep of the new system. Chute
describes implementation of ICD–10 as "expensive, arduous, disruptive, and of limited clinical
benefit" (Chute 2012: 839). ICD–10 includes more descriptive and specific diagnostic codes, but its
ability measure clinical data is not better than its previous version (Chute 2012: 839). Pear also
agrees that the new coding system requires more strenuous work for physicians. Physicians would
have to be even more specific with claims, and if re–submission is an option it also requires extra
effort (Pear 2015: ... Show more content on Helpwriting.net ...
However, not all practices think ICD–10 is bad, spine surgeons specifically believe an increase in
cost–efficiency. Rahmathulla discusses all the benefits from ICD–10 especially when performing
existing and new surgical procedures. The nature of ICD–10 allows for codes to describe illnesses
and injuries in more detail, meaning new and existing procedures are also accounted for in those
new codes. The issue with spinal procedures and ICD–9 was that the old version didn't include
appropriate coding for necessary tests and procedures for patients. Practices are frustrated because
surgeons weren't performing certain procedures for reimbursement issues, resulting in patients not
being approved for necessary procedures (Rahmathulla 2014: 189). Long–term implementation of
ICD–10 saves "approximately $100–$1500 million", which could be used as funds for new
procedures. Barriers always exist, but long–term benefits have

Medical Billing: A Case Study
Health Care Setting
Medical billing is the health care area selected for the discussion. Medical billing is the process of
submitting and tracking claims with health insurance companies in order to receive payments for the
services rendered by healthcare providers to ensure business finances success.
(https://en.wikipedia.org/wiki/Medical_billing). Usually, the process is performed by electronic
means and each claim must be a mirror image of the patient encounter. Although electronic billing
carries sensitive information most practice management billing software relies on the clearinghouse
which converts the data into HIPAA format. Thus, information is encrypted to minimize any
unauthorized access. The actual diagnosis code system will be replaced by ICD–10 on October 1,
2015. Hence, the need for greater coding accuracy and specificity has heightened considerably since
the implementation of ICD–9–CM (Bowman S., 2008).
Interoperability Impediment ... Show more content on Helpwriting.net ...
For this reason, is so arduous to report and capture international data in areas of public health, top
mortality disease rates, or threatens related to bioterrorism. The situation worsens since clinical
research, reimbursements, patient safety monitoring, quality and outcome measures are negatively
impacted by the limited outdated coding system. In contrast, ICD–10 present additional details of
patient conditions as well as the healing process. For example, the actual system does not provide
specific information for a woman with breast cancer while ICD–10 report details of the neoplasm
such as the exact, location by quadrant, side, size, or even the

International Classification Of Diseases (ICD)
The International Classification of Diseases (ICD) is used by physicians, nurses, other providers,
researchers, health information managers and coders, health information technology workers,
policy–makers, insurers and patient organizations to classify diseases and other health problems
recorded on many types of health and vital records, including death certificates and health records.
In October of this year, the long–standing International Classification of Diseases, 9th Edition,
Clinical Modification (ICD–9–CM) will be replaced by the International Classification of Diseases,
10th Edition, Clinical Modification/Procedure Coding System (ICD–10–CM/PCS).
The new classification system provides significant improvements through greater detailed
information and the ability to expand to capture additional advancements in clinical medicine. . The
new coding system switch comes at a very demanding time for the healthcare industry. New
requirements introduced by the Patient Protection and Affordable Care Act (healthcare reform) and
meaningful use requirements established by the HITECH Act, will result in a tsunami of business
process changes and application integration challenges. In implementing this new code set, a single,
centralized, controlled point of reference for disease and procedure codes, rules, mappings, and
translations that can be applied uniformly to all applications must be established. ... Show more
content on Helpwriting.net ...
ICD–10 contains 141,060 codes which is 121,243 more codes than ICD–9. Additionally, to further
complicate matters there isn't a one–to–one relationship between codes contained in ICD–9 and
ICD–10, the relationship between the two code sets are many–to–many. One code in ICD–9 can link
to more than a dozen codes in ICD–10 and conversely so, one ICD–10 code can link to multiple
ICD–9 codes. Lastly, there are some instances where no map exists between the code

10-Cm Vs Icd-9
The United States implemented the current version (ICD–9) in 1979. ICD–10– CM is the mandated
code set for diagnoses under the HIPAA Electronic Health Care Transactions and Code Sets
standard starting on October 1, 2014. While most countries moved to ICD–10 several years ago, the
United States is just now transitioning into ICD–10 and has to be compliant by October 1, 2015.
ICD has been revised a number of times since the coding system was first developed more than a
hundred years ago. ICD–10 – CM is a three– to seven character alphanumeric representation of a
disease or condition. The first digit is alpha; Digit 2 is numeric. There is a decimal placed after the
third character. There are 69,000 codes to better capture specificity, tis also

ICD-10 Code Sets and Health Care
Originally slated for October 1, 2014, the Centers for Medicare & Medicaid Services (CMS) had
planned to replace the current ICD–9 codes sets with the new ICD–10 code sets. However, on
March 31, 2014, the Senate approved a bill that has delayed the implementation until at least
October 2015. The numbers of the ICD means "International Classification of Diseases" (ICD) and
the numbers nine and 10 describe therefer to "editions," just like with books. ICD defines
designations prescribed for every possible description of symptom, cause of death, or diagnosis that
a human may experience. These codes are utilized used for reporting medical diagnoses as well
asand inpatient procedures, according to the CMS. Everyone who works in conjunction with the
Health Insurance Portability Accountability Act (HIPAA) is required to adopt these code set
changes. The CMS has issued a reminder that ICD–10 will not impact affect coding for physician
services and outpatient procedures.
The World Health Organization (WHO) is the entity which monitors, copyrights, and develops the
classification system. However, tThe National Center for Health Statistics (NCHS), a part of the
CMS, is the entity which oversees the U.S.–specific modifications and changes to ICD codes in
collaboration with WHO. According to WHO, ICD is "the standard diagnostic tool for
epidemiology, health management and clinical purposes. This includes the analysis of the general
health situation of population groups. It is used to

Icd 10 : A System Of Medical Classification Of Diseases
ICD–10 stands for International Classification of Diseases, Revision 10. ICD–10 is a revision of the
ICD–9 system which physicians and other providers currently use to code all diagnoses, symptoms,
and procedures recorded in hospitals and physician practices. There are two main types of ICD–10
coding books, the International Classification of Diseases, Revision 10, Clinical Modification (ICD–
10–CM) and the International Classification of Diseases, Revision 10, Procedure Coding System
(ICD–10–PCS). ICD–10–CM is a system used by physicians and healthcare professionals to code
diagnoses and procedures that occur in American hospitals. ICD–10–PCS is a system of medical
classification used for procedural coding. The implementation of ... Show more content on
Helpwriting.net ...
For example, with ICD–10 codes a physician can simply look up disease patterns that relate to the
patient that he/she is currently seeing. If the patterns match up to a prior patient that has been
diagnosed with all of the same problems as the new patient, then the physician will be able to make
an educated decision to diagnose the new patient with the same diagnoses. This coding system will
not only improve patient's documentation and help with diagnosing other patients; it will improve
the physician's overall experience with his/her patients. Many practices have lost patients because of
misdiagnoses or by giving a patient medicine for a disease that they do not have. These common
mistakes are made by physicians and having a better analysis of disease patterns will help the
physician narrow down the choices of diagnoses. (ICD–10 Benefits Beyond Coding) Additional
benefits for patients from ICD–10 include better detection of fraud and abuse. There are many cases
where an individual had used another individuals health insurance benefits for their own personal
use. For example, there was a case from July 7, 2015 where a physician underreported his income
and claimed millions in false and fictitious medical supply expenses. The physician was caught and
sentenced 24 months in prison and was ordered to forfeit 17.6 million dollars. With the improved
coding system it will be more

Icd 9 Case Study
Since the implementation of ICD–9 coding in 1979, we have made great breakthrough's in the
medical field. However, the time had come for the U.S. to expand on its coding procedures, and
implement the new version of coding, ICD–10. ICD–10 requires doctors and medical staff to be
even more specific about an illness or injury. What exactly are the problems facing ICD–10 coding
systems, and what have we encountered since it was implemented? According to Donna Smith, an
RHIT and senior consultant at 3M Health Information Systems, she says there are specific problems
concerning the types of codes, matching the illnesses or injuries, and there are overall problems, like
training. (ahima.org) She mentions examples of specific coding illness and ... Show more content on
Helpwriting.net ...
Insurance companies and state health care management agencies must have these conditions coded
correctly to reimburse the hospital or physician's office for patient treatments. With these new
changes, it is making it easier to specify injuries and diseases for a patient and keep data updated.
DRG weights take into consideration the demographic of the patient, location demographics, and
other criteria. If the patient is in a poor location, then they should not be penalized with a huge bill
for health treatment they cannot afford. This keeps hospitals and other health facilities from price
gouging patients that cannot afford insurance or any type of healthcare. With the implementation of
the ICD–10 coding system, many problems and challenges have arisen. Teaching the physicians and
other medical staff how to correctly code with the new system has been first and foremost a
problem. Also, if medical coders don't have the correct codes marked, they can just revert to the
"non–specific" code, and this will eventually throw off their collected data and could possibly
hamper their efforts for full reimbursement. For a certain facility, I would review all medical coding
issues and present them in a list of most problematic to the least, starting with the top 10. I would
hold meetings to present

Request for Proposal Computer Assisted Coding
Request for Proposal
Computer Assisted Coding
HIM 4411Section 700 HIS Strategies and Application
March 8, 2013
Due to the growing inpatient/outpatient requirements, as well as the impending update to the ICD–
10 codes; the spearfish regional hospital is in dire need of a new Computer assisted coding system
(CACS) with ICD–10 code language. This technologies will assist the coding department with their
day to day processes, as well as allow the hospital to continue with its growth to meet the higher
demands of our growing community. Included in this report will be a detailed report of the
technologies being requested, as well as information on these vendors 3M, Nuance, and Optum who
can supply these ... Show more content on Helpwriting.net ...
The only department that will be utilizing the computerized coding assistant is the health
information department mainly our coding staff. The HIM staff will mainly use this system in order
to help smooth the coding process of charts, check to make sure all codes are correct before being
submitted for billing, and to help them identify codes for diagnosis or procedures they are
unfamiliar with. The receptionists in the different departments may also utilize the system if a time
were ever to arise in order to assist the coders with work load.
The only projects that the organization is currently undergoing is the preparation for the
implementation of the new ICD–10 coding. We are hoping that with the new computer coding
assistant that it will help the HIM staff transition better and be able to look up the new codes for all
the diagnosis and procedures more easily and quickly.
Product Scoring Tool
System requirements scoring
0 – 1 points
1 – 2 points 2 – 3 points 3 – 4 points
Total Points
Win 7 or higher
No
Updateable
Yes

ICD–10 format
No
Updateable
Yes
Tech support
Training only
Training and
Troubleshoot
Full support
Web based
Yes
Both Optional
No
Installation
None Offered
Over the
Phone installation
Remote
Installation
Supervised Installation

Diagnostic Coding Summary
Diagnostic coding is one of the most critical parts of medical coding. If the correct diagnostic code
is not selected, a claim may be denied (Deborah Vines, 2013, pp. 88–125). Using the ICD–9–CM,
diagnosis coding became mandatory for Medicare claims since the Medicare Catastrophic Coverage
Act of 1988. In 1948, the ICD came under the direction of the World Health Organization, which
assisted in tracking deaths and sicknesses to help make statistical assessments of international health
and disease trends (Deborah Vines, 2013, pp. 88–125). Medical terminology plays a key role in
proper diagnosis coding. You must be able to read and understand the physician's documentation to
identify the appropriate codes for medical conditions that pertain ... Show more content on
Helpwriting.net ...
Procedure codes are linked with diagnostic codes to establish the medical necessity of the procedure
and the fee reimbursement to the providers (Deborah Vines, 2013, pp. 146–163). There are three
categories for CPT. CPT Category I codes describes a procedure or service and are subjected to a
lengthy approval process conducted by the CPT Editorial Panel. CPT Category II codes are a set of
optional tracking codes, developed principally for performance measurement (Deborah Vines, 2013,
pp. 146–163). CPT Category III are temporary codes that are intended to be used for data collection
purposes to substantiate widespread use of new technologies, services, and procedures or those that
are in the FDA approval process. CPT Nomenclature consist of descriptive terms, guidelines, and
identifying codes for reporting medical services and procedures (Deborah Vines, 2013, pp.

ICD-10-CM Transition Analysis
I think transitioning over to ICD–10–CM will make coding easier by being more specific with the
descriptions. I think that the biggest challenge is going to be just learning the different sections of
the ICD–10–CM. Some other challenges may include training in ICD–10–CM, the cost of the
transition, and maintaining two coding systems because some private insurance like workman
compensation insurance are not required to switch over to ICD–10–CM. I believe that we have had
ICD–9 since 1979 with updates yearly, which makes the ICD–9 over twenty years and almost thirty
years old. A lot has changed in the medical world since then and we are due for a change. Anything
new will take some time to learn and I believe that the transition would be

International Statistical Classification Of Diseases And...
In today's technological world patients are choosing where they receive their care based on research
and public access to hospitals quality of care numbers. Hospitals are competing with other hospitals
for patients. In order to attract patients hospitals are improving their quality of care by providing
safe and efficient care. Advancements in Medical Technology has made it possible for Health care
providers to better diagnose and treat their patients, one of those medical advancements is
conversion of International Statistical Classification of Diseases and Related Health Problems 9th
edition (ICD–9) to International Statistical Classification of Diseases and Related Health Problems
10th edition (ICD–10).
ICD–10 a medical classification list went live on October 1, 2015 for U.S healthcare industry after
experiencing many lengthy. The adoption of ICD–10 codes offer many more relegation options
compared to ICD–9 (Rouse, 2015). With ICD–10 codes, healthcare officials properly document
diseases on patient's charts, government agencies track epidemiology trends, and insurance carriers
assist in medical reimbursement decisions. ICD–10 codes are developed by The World Health
Organization (WHO) and are adopted by the rest of the healthcare system in the United States.
ICD–9 was introduced in 1979. With the advancement in medicine and the direction healthcare has
gone into a new set of coding was needed that supported advances in modern technology and
medical devices.ICD–10 is

ICD-10 Code Transition Analysis

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ICD-10 Code Transition Analysis