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Feeling Better About ICD-10

Cheryl Clark, for HealthLeaders Media, January 13, 2012
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For example, ICD-9 has no way of classifying certain serious foodborne illnesses, such as clostridium perfringens, but ICD-10 does. And ICD-10 is much more specific about syphilis, HIV, and pneumococcal infections.

3. Discourages upcoding, fraud
One potential for ICD-10 is that with more specificity, it will be a lot tougher for hospital coders to lump patients into a more severe disease or procedure category. "In an ICD-9 world, codes are more ambiguous," says Bowman. "It will be harder for people—when they encounter something that seems initially like it's on the border of one code or another—to say, ‘I think I can get this into this [higher-paying] code.' We'll be seeing a lot less of that with ICD-10."

For example, ICD-10 features a way of identifying each side of the body.  Bowman says that if a patient seems to be having numerous procedures on the same foot, either the treatment "isn't effective" or it may be a billing misadventure, she says. "It helps with fraud, because payers can check for multiple encounters/treatment for the same anatomical site."

4. Specifies reasons for patient noncompliance
As providers are increasingly held accountable for patient outcomes, a huge concern is how to classify the patient who fails to follow a recommended regimen of care and gets sicker as a result. Under the current system, there is only one code for such a patient. But in ICD-10, there are at least eight. For example, one of the eight codes indicates these variations: intentional underdosing due to financial hardship; unintentional underdosing due to age-related debility; noncompliance with renal dialysis.

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