What is the ICD-10 Code?

Understanding the ICD-10 Code for Your Private Practice

As a clinician, we use specific codes to diagnose our patients in an effort to achieve more evidence-based practice. This also helps insurance companies understand why the care was necessary in the first place so they can process our claims. 

And while it’s not always easy keeping up with the laws of Billing & Coding and navigating the world of Insurance companies, there are some constants and patterns that you can expect in your clinic. 

Among these is the popular ICD coding system. 

Below are some frequently asked questions about ICD-10 that we’ve answered so our private practice owner community is empowered to keep their practice running with the proper standards and compliance necessary to be successful. 

What is the ICD code?

Known as the International Classification of Diseases and Related Health Problems (ICD) is a medical classification that uses codes for things like diseases, symptoms, causes of injuries, etc. that can be documented on patient paperwork like hospital records, medical charts, visit summaries, and bills. These codes better inform medical professionals to ensure the diagnosed receives proper treatment and is charged appropriately for any medical services they receive.

When did ICD-10 code start getting used?

Work on the 10th version of the coding system, ICD-10, started in 1983 and was completed and put into use in 2015. It contains more than 70,000 disease codes. ICD is maintained by the World Health Organization (WHO) and is distributed in countries all over the world. It will be replaced by ICD-11 in 2022.

What is the ICD Code used for?

The World Health Organization publishes the ICD codes in order to standardize methods of recording and tracking instances of diagnosed disease, making it possible to conduct research on their causes and their treatments. 

In terms of insurance, having the correct code is important for being reimbursed for medical expenses and ensuring that the standardized treatment for your medical issue is received. This code shows insurance companies why the care you provided the patient was needed based on the diagnosis. In fact, ICD-10 can help clarify a variety of things including cause, manifestation, location, severity and the type of injury or disease.

What is the ICD-10-CM code distinction?

The ICD-10-CM is a Clinical Modification of the ICD-10 code as authorized by WHO. It replaces the ICD-9-CM diagnosis codes used previously, which were 3-5 characters with the first character being alpha or numeric. They are now 3-7 characters with the first character always being alpha.

Who can use the ICD-10 code? 

ICD codes are typically used by healthcare professionals. This can include healthcare personnel, such as physicians and nurses, as well as medical coders (or billers). As we mentioned above, ICD codes are used for a variety of purposes, including statistics and for billing and claim reimbursements.

Does the ICD-10 code change?

Yes, the ICD-10 code changes annually on October 1st. Typically, the ICD codes change and increase in number to become more specific as they break down diagnoses into more and more granular or precise definitions. 

Practitioners and therapists must keep up-to-date with any code changes or risk using an outdated ICD-10 code on a bill which means that their client’s claim will be automatically rejected by the insurance company.

In what order should I list my ICD-10 codes?

According to the APTA, this is the order to list your ICD-10 codes.

First, list the ICD-10-CM code for the diagnosis, condition, problem, or other reason for the patient visit shown in the medical record to be responsible for the services provided. 

Next, list additional codes that describe any coexisting conditions. In some cases, the first-listed diagnosis may be a symptom when a diagnosis has not been established by the provider. APTA notes that codes for symptoms, signs and ill-defined conditions are not to be used as principal diagnosis when a related definitive diagnosis has been established. 

Do therapists need to use all the codes in ICD-10?

Just as no healthcare provider uses every code in ICD-9-CM, therapists will not use all the codes in ICD-10-CM. They will typically just use a subset of codes based on their practice and patient population. 

Basically, the ICD-10-CM code set is like a dictionary with thousands of word choices, and, similarly, people use some words commonly while others are never used, according to the American Health Information Management Association.

Where can I find specific ICD-10 codes?

We recommend using this website to find specific ICD-10 data. It features an easy-to-use search tool to identify the right code for you.

Get More From Your Private Practice Billing Services

Have any additional questions about your private practice billing codes or services? MEG Business has over 50 billing specialists on our team ready to help get you the answers you need.

Contact us today to learn more or request a billing assessment.

References for this article include Wikipedia, Very Well Health, National Cancer Institute, CDC, APTA and American Health Information Management Association.

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