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ICD-10-CM A Look Ahead: Considerations for Adopting, Implementing & Using ICD-10-CM

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      In less than a year the switch will flip to ICD-10-CM, and most health industry stakeholders agree that the moment has the potential to make or break a practice. Many practices have embraced adoption and the systematic upgrades that are associated with implementing the new ICD-10-CM diagnosis code data set. Others have chosen a watch and wait approach, hoping the regulation will be repealed or that a magician of sorts will make ICD-10-CM disappear. However, considerations should be given to the massive financial investment for electronic health infrastructures that public and private stakeholders have already made - including upgrades that will support the use of ICD-10-CM. ICD-10-CM implementation is viewed by stakeholders as an important step toward transparency in the delivery of healthcare services and the payment of claims.

      The use of ICD-10-CM will be a critical component to changing the manner in which healthcare outcomes are reported, quality and efficiency are measured, and reimbursement models are restructured for physicians and facilities.

      The genesis of ICD-10-CM

      Let's review the background of ICD-10, the precursor of ICD-10-CM. ICD-10 was developed in the early 90s by the World Health Organization, and it has been used in various countries for morbidity and disease pattern tracking. However, the United States has been using ICD-9-CM, an earlier version of the diagnosis code data set. The arguments for transition to the new code set have included that ICD-9-CM is obsolete and describes old technology and procedures. In early 2009 and prior to the enactment of the Patient Protection and Affordable Care Act (PPACA), the Department of Health and Human Services changed regulations associated with the Administrative Simplification Rules under the Health Information Portability and Accountability Act (HIPAA). These changes called for a shift from use of the ASC X12 Version 4010 programming for claims to ASC X12 Version 5010, and it also called for the use of ICD-10-CM versus ICD-9-CM. The Affordable Care Act further reinforced the need for interoperability standards and the adoption of electronic medical record technology within the medical practice.

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