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ICD-10 Medical Codes Changed On October 1- What Does This Mean?

Here are the answers to frequently asked questions.

What are ICD-10 codes?

ICD, or International Statistical Classification of Diseases and Related Health Problems, codes are the worldwide standard for tracking illness, injury and disease.  All health plans, medical facilities and physicians under Health Insurance Portability and Accountability Act (HIPAA) are required by federal mandate to use ICD-10 codes with dates of service of Oct. 1, 2015 or later.

Why the move from ICD-9 codes to ICD-10 codes?

The transition for medical providers and all insurance plan payers is a significant one since the 18,000 ICD-9 codes are to be replaced by 140,000 ICD-10 codes.  ICD-10 replaces ICD-9 and reflects advances in medicine and medical technology over the past 30 years. Doctors and hospitals use ICD codes to classify diseases, illnesses and injuries, and insurance companies use this information to process claims. The expanded code sets in ICD-10 allow for more detail in diagnosis and procedure codes.

Some of the codes appear strange, why are they needed?

Crazy ICD-10 codes have been published all over the internet like contact with a kitchen utensil, injury in an art gallery, crushed by an alligator, burn due to water-skis on fire, lips stuck to musical instrument, very low level of personal hygiene, struck by duck, walked into a lamp post, knitting accident, holiday exhaustion, etc.  The transition from the 1970’s based codes to today will provide health care givers and agencies like the Centers for Disease Control (CDC) more information on how to treat disease, what demographics are more likely to contract certain diseases, more specificity on illness and injuries like - which particular bone was broken, where someone was injured, how exposure to different outside factors may result in injury or illness, etc.  It is expected that this additional information will help to shape treatment protocols in the future, anticipate needed vaccines, and understand and communicate more specific prevention techniques

How does this affect me?  

The significant transition for medical providers and insurance companies could cause delays or errors in billing or claim payments, in the short term, as all affected businesses work to comply.  Watch your medical bills and explanations of benefits closely to make sure that information is represented correctly and you are receiving the right benefits.