ICD 10 Overview
This lesson explains the basics of the ICD-10-CM system and some of its uses in healthcare settings. It follows Joan, a new coder at Crawford Ambulatory Center, as she learns the importance of accurate coding for medical reimbursement and the broader applications of the ICD-10-CM system.
Medical Reimbursement Coding
During an evaluation, Joan asks her manager why ICD-10-CM codes are so important and why they should be double checked with a doctor if there are discrepancies. She is new at Crawford Ambulatory Center and is learning how to code for medical reimbursement. She feels that it slows down her productivity when she double checks information.
A manager explains the purpose of the ICD-10-CM system to Joan.
ICD-10-CM System Basics
The initial intention of this international classification system was to determine the reasons for death. Established in 1893, the ICD has expanded its scope to encompass both mortality and morbidity data.
ICD-10-CM, which stands for International Classification of Diseases, Tenth Revision, Clinical Modification, is published by the World Health Organization (WHO) and serves as a universal diagnostic coding system that aids in identifying health patterns, illnesses, and medical conditions for research purposes.
Additionally, it facilitates communication across countries by providing:
- Information that is easily accessible and based on evidence
- Publicly available medical information that can be compared between regions, countries, and hospitals
- Tracking data over time in the same location to identify trends
ICD is published by the World Health Organization
The manager continued to explain the importance of accurate ICD-10-CM coding to Joan, who had no idea that the ICD system had existed so long.
ICD-10-CM Uses
Throughout the years, ICD’s purpose has expanded and its data is used for a variety of purposes. For example, ICD-10-CM is used to:
- Assess and monitor safety, efficacy, and quality of care
- Make health policy decisions
- Identify risks for public health
- Guide utilization of resources
- Develop reimbursement and payment strategies for medical organizations and insurers
- Prevent and detect fraud
- Conduct clinical trials and epidemiological studies
- Systematize healthcare delivery
- Improve the performance of finance, administration, and clinical departments
- Keep track of disease prevalence and death occurrences
Joan is most interested in how the ICD-10-CM can be used in reimbursement and payment by her medical organization and insurance providers.
In addition to types of diagnoses and diseases, she knows that the codes represent symptoms, procedures, reasons for medical visits, and health risks as well.
For example, type 1 diabetes is coded E10. Diabetes-related kidney complications are coded E10.2.
Joan’s manager stresses the significance of her ICD-10-CM code knowledge in reporting patient and medical information accurately to insurance companies and the state. Thus, any discrepancies between codes in a patient’s record must be verified with the attending physician.
Any mistakes could result in reimbursement issues for the organization and incorrect data for other purposes of the ICD system.
Joan comprehends the importance of her role within the organization. Additionally, she welcomes the updates made in the recent ICD-10-CM revision.
ICD Codes Must Be Accurate in Medical Records
Coding Impact of ICD-10-CM
As a result of the revisions to ICD-10-CM, coding, reporting, and documentation will be improved. More detailed coding allows for more specific information to be documented.
New codes include updated terminology and have clear instructions for use. A non-specific code can also be used when necessary in the revision.
Having known that slowing down production will not be frowned upon at her job, Joan feels more comfortable at work now.
In order to make sure the correct ICD-10-CM codes are being reported, it may be necessary to double check information.
To continue to improve at her new job, she anticipates a follow-up evaluation from her manager in several weeks.
Summary of the Lesson
- The World Health Organization published ICD-10-CM, which is used globally.
- ICD-10-CM codes medical information which can be used to compare data in different areas and regions as well as track it over time.
- In the beginning, the ICD system was developed to identify causes of death.
- Throughout the years, the system has been expanded to include codes for diagnoses, diseases, symptoms, procedures, and reasons for medical visits.
- ICD-10-CM is used to ensure quality and safety in healthcare, develop health policies, assess public health risks, and determine how resources should be allocated.
- A coding system like this can also be used to plan or streamline healthcare performance, prevent healthcare fraud, develop reimbursement and payment strategies, and track disease prevalence and death occurrences.
Course Glossary
ICD 10
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ICD Glossary
Course Glossary ICD 10
Download the complete volume of ICD 10 international coding.
Worksheet on This Unit
In the quiz that follows this unit, use the exam found in your course reference under the last unit of module one to answer the questions. The quiz is the ICD 10 quiz. Answers are included to help you along.
Please read the next unit and come back and try the quiz again if you need more attempts.