mardi 18 février 2014

The ICD-10-PCS And Its Implementation

By Violet Solomon


The International Classification of Disease 10th revision Procedure Coding System is normally abbreviated as ICD-10-PCS. This is a system of medical classification that helps to procedurally give coding to health interventions that the medical professionals may choose. The World Health Organization normally publishes PCS so as to track the international morbidity and the mortality statistics for comparison.

The code consists of between three to seven digit alphanumeric codes all specifying the procedure. The first digit of the code is used to indicate the area of medical practice such as monitoring, measuring, surgery and administration among other. The rest of digits indicate the body system, the root operation, the body part, the approach used and the devise used in the procedure. The seventh character is the quantifying digit.

The ICD-10 replaced the ICD-9 version and is set to take effect in October 1, 2014 bringing about drastic changes in the entire health sector in United States affecting all players from federal government, state governments, insurance firms, medical facilities to health professionals. The ICD-10 has two major components, the ICD-10-CM (CM being abbreviation for clinical modification) and ICD-10-PCS (PCS for Procedure Coding System).

While the ICD-10-PCS are used for in-patient procedures and studies, the same cannot be used when it comes to billing of the radiologist professional components. They are also not applicable for procedures and studies concerning out-patients. The implication is that this coding system describes the procedures that are performed on in-patients but the identical procedures performed on out-patients are still described by the original CPT codes.

The auto insurance industry, legal claims and workers comps will not be converting to the new ICD-10 codes forcing hospitals to provide a mixture of CPT, ICD-9, ICD-10 and ICD-10-PCS in general management and billing system. For this reason, every player should have the capacity, ability and knowledge on when to and how to automatically convert from one coding system to the other and back. This should also be done with ease, efficiency and comfort as much as possible.

Given that some players like the auto insurance, legal claims and workers comps are not expected to convert to the new coding system, the hospitals are likely to use CPT, ICD-9, ICD-10-CM and ICD-10-PCS all at the same time. This calls for capacity evaluation, ability training and general knowledge in the part of healthcare providers to keep up to the demand of converting from one coding system to the other and back in an efficient and easy manner.

If you choose the option of upgrading the system as required, there are a few challenges that you need to prepare for as suggested by studies done on countries that have already converted to the new coding system. These include increased time per claim for coders, need to additional staff, concurrent processing of ICD-9, 10 and the new in-patient code, disruption of reimbursements and possible backlog of programming requests.

The last minute rush, expect confusion and delays as hospitals, clinics, surgery centers, insurance companies, the CMS, the State Medicaid and all other healthcare providers try to comply in October 1, 2014 should be avoided. There are concerns arising from the implementation of ICD-10-PCS such as the possibility of using detailed information from this code to exclude coverage by the government and private insurance.




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