Hospital, Clinic Adopt New Medical Codes
Posted on Friday, October 2nd, 2015
Studying New Medical Codes -- Medical coders
Misti Kirk, front left, Connie Barker, Linda Dixon,
back left, and Evelyn Bean lead the switch to the
nation's new medical coding system at Mercy Health/
Love County.
Mercy Health/Love County joined the rest of the U.S. healthcare industry in switching to a new medical coding system on October 1.
The new codes will be used to authorize and calculate payments from Medicare, Medicaid, commercial insurers, Tricare, and the Veterans Health Administration to the hospital, clinic, and EMS.
Medical coders described themselves as "ready but apprehensive" for the big change.
"We have been training for a year to get ready, and we are comfortable with out preparation, but until we code for that first patient on October 1 and file that medical claim, we won't fully realize what the new system entails," said Linda Dixon, manager of the Health Information Services Department, and Registered Medical Coder.
Twenty-five countries around the world utilize a common medical coding system for reimbursement. The U.S. is last to adopt ICD_10, the 10th revision of the International Statistical Classification of Disease and Related Health Problems.
ICD-10 is a much more complex and detailed coding system. For physicians, there are about 68,000 diagnostic codes, five times more than under ICD-9. For hospital-based procedures, there are 87,000 codes -- 29 times more codes than in ICD-9. Instead of coding with three to five digits, entries will now involve a combination of seven digits and letters.
Put simply a claim for treatment of a fractured finger would now go on to detail in code the type of fracture, the joint impacted, and how the break occurred.
Medicare, Medicaid and the commercial insurance companies are learning the code, too, and may take longer to process claims, leading the hospital and clinic to plan for disruption of their normal revenue stream.
"With the higher level of coding detail, it is reasonable to expect we are going to experience some claim delays for the next several months," said Connie Barker, clinic director, and Registered Medical Coder. "We have set aside financial resources to minimize cash flow problems during the transition."
Dixon said more knowledge of anatomy and physiology is required of coders than before. They must be adept at medical terminology for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease.
Coding for the hospital besides Dixon (Impatient Records) is Evelyn Bean (Outpatient Records). Jamie Girard, a medical records specialist, handles claim inquiries from insurance companies.
Joining Barker in coding duties for the clinic is Misti Kirk, who also answers claim inquiries from insurance companies.
Coding is an electronic operation. First, the physician enters a diagnostic code at the time of care. Then, the medical coders enter procedure codes and classification codes to round out a medical claim for payment.
Barker said claims for payment go out within 7-10 days after the patient is treated. The patient's primary insurance company has 60 days to compute an estimate of benefits. The secondary insurance company, if there is one, then takes up to 60 days to compute its estimate of benefits. Finally, the patient is billed for any remaining balance due.
Claim inquiries create delays at each level.
The U.S. had used ICD-9 since the 1970s. Adoption of ICD-10 has been repeatedly pushed back since 2009. The Centers for Medicare and Medicaid Services guided the adoption and set up workshops for physicians, staff members, and administrators.
The World Health Organization developed the ICD healthcare diagnostic and procedural coding system.