by Find-A-Code™
Jun 6th, 2024
ICD-10 codes impact everyone who utilizes healthcare services in the U.S. Going one step further, the codes are used worldwide for medical billing and data analytics purposes. A professional medical coder or biller would be expected to understand the codes thoroughly. Others in the industry have a less thorough knowledge of them. As for consumers, most know little to nothing about ICD-10 codes.
That is not a bad thing. Medical billing codes are a complicated matter. Unless one works in the medical coding or billing field, there really is no need to understand the finer points of code sets. Still, there might be some things average consumers would find interesting.
Code Development and Publishing
Medical coders and billers work with a variety of code sets. The two most common are ICD-10 and CPT. ICD-10 codes are developed and published by the World Health Organization (WHO). Note that the WHO also owns the copyright for the code set.
Similarly, the American Medical Association (AMA) develops and publishes the CPT code set. They also own the copyright for this code set. ICD-10 codes are diagnosis codes while CPT codes are for procedures.
A Modified Code Set in the U.S.
Here in the U.S., we utilize a modified version of the ICD-10 code set to align with some of the unique features of our healthcare system. The modifications are largely due to specific needs among two federal agencies:
- The CDC's National Center for Health Statistics (NCHS).
- The Centers for Medicare and Medicaid Services (CMS).
Because the CDC and CMS require modified codes, the two agencies are responsible for adapting and maintaining the ICD-10 code set in this country.
What the Codes Mean
ICD-10 codes are anything but random. They have been designed and structured in such a way as to allow them to contain a lot of information in just seven characters. Here is a breakdown of each section of a code and what it means:
- The Diagnosis – The first section of the code represents the diagnosis of the disease in question. It consists of a single letter and two numbers. The letter represents a broad disease category, like cancer (C) or infectious disease (B).
- Separator – A period follows the first three characters. It acts as a separator between the diagnosis and additional details.
- Additional Details – The final three characters offer additional details. For example, they might describe how severe the condition is, where on the body it is located, or a known cause of the disease.
With these seven characters, a medical coder can accurately describe a patient's diagnosis in standard terms that are understood by billers and payers alike. It is almost as though ICD-10 codes are medical billing shorthand.
Some Codes Follow Patients
ICD-10 codes directly impact patients whether they know it or not. For example, some types of codes follow patients around from one medical provider to another. These are generally codes pertaining to chronic health conditions.
Now that our healthcare system has largely adopted electronic health records (EHRs) it is entirely possible for a patient to utilize a local emergency department for the very first time, only to discover that the doctors and nurses in that department know about the patient's chronic health issues. That is because the ICD-10 codes are included in the patient's personal history.
What has been described in this post barely scratches the surface of ICD-10 codes or medical coding in general. If you are a professional, you probably know all this information already, otherwise, much of it may be new to you. There is a lot more to learn if you are interested.
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