Like it or not, accurate medical coding is essential for any health care entity to be paid. ICD codes, or International Classification of Diseases codes tell the insurance companies why a patient had a medical procedure or test performed. The WHO implemented ICD-9 codes in 1979 and they did not change until 2015! An interesting fact is ICD-10 codes were introduced in 1993, however, we did not get them live until 2015, with the final update finished in 2019! ICD-11 was supposed to come out in 2022, but unless you are a fish I would not hold your breath. ICD-10, approved by the World Health Assembly in 1989, is used in over 100 countries and has been translated into 43 languages.
How ICD Medical Coding Works
ICD coding is used to evaluate health care costs, predict future healthcare costs, process and receive payment from insurance companies, and most importantly for you, and us to track utilization of services. As boring as it may seem to many of you, proper coding is CRITICAL to receive payment for services performed. Every time new coding comes out it requires one to be more specific when sending a claim for services. The more that is learned about a disease the more specific the ICD codes become. It is important to remember the patient is in your office and you know exactly what is going on. The code you put down is telling the insurance claim adjustor who lives 10 states away what your patient has at the time you see them.
An Example of ICD Coding
As an example, your patient presented with signs and symptoms of some type of urinary tract infection that occurred after a wild night in South Beach, Florida. Your provider decides to order lab work for a UTI and a sexual health panel. Using N39.0 might be sufficient for the UTI lab work because the provider does not know what type of UTI the patient has (upper or lower urinary tract infection, etc), however without a specific sexual health ICD code any sexual health tests done would not be covered by the patient’s health insurance. If Z20.2 (Contact with and exposure to infection with a sexual mode of transmission) was added as a second diagnosis, it becomes evident in the insurance company’s eyes why the test was ordered and the odds are they would pay for the service.
Why We Need Accurate Coding
Remember the insurance company is obligated to provide the services for which their customers pay the premiums. If we do not get them the information necessary to make it easy for them to pay, the patient becomes responsible for the bill. Good documentation and great specific coding will save many a clinic from getting that irate patient phone call wondering why their insurance company is not paying. Of course, the insurance company would never throw the providers or the lab under the bus…….Uh Huh!
Thank you all for being as specific as possible and for the great service you provide to your patients. As always we appreciate your trust in us.
President/CEO Industry Lab Diagnostic Partners