There’s a good chance you went into practice to help more people embrace wellness and feel their best. But you’re also running a business, and that means you need to get paid for your services in a timely manner.
Navigating the reimbursement landscape is complex when you’re dealing with insurance companies, Medicaid, Medicare or other third-party payers. Understanding the ins and outs of ICD-10 codes (International Classification of Diseases, 10th Edition) can help you avoid costly errors that lead to delays, denied claims, and compliance risks.
This article will help you understand the importance of ICD-10 codes, provide guidance on how and where to access them and share links to the latest resources and tools for boosting your ICD code confidence.
ICD-10 codes are a standardized system used worldwide to classify and code various diseases and health conditions. The codes are a foundational tool for ensuring consistency in healthcare documentation, billing, and health data analysis across the healthcare industry and public health sectors globally.
The World Health Organization (WHO) develops and maintains ICD codes. According to the WHO the codes provide "a common language for recording, reporting and monitoring diseases. This allows the world to compare and share data in a consistent and standard way – between hospitals, regions and countries and over periods of time. It facilitates the collection and storage of data for analysis and evidence-based decision-making.”
The WHO periodically revises the ICD system. ICD-11 came into effect on January 1, 2022. Since ICD-10 dates back to the 1990s, ICD-11 reflects advances in knowledge of diseases and their causes. If you’re wondering when ICD-11 might affect you, rest assured that the timeline for adoption and implementation is up to individual countries. For context, the US transitioned to ICD-10 almost a decade after it was adopted by the WHO.
US healthcare providers use a version of ICD-10, known as ICD-10-CM where CM stands for "Clinical Modification." These codes provide additional clinical detail essential for healthcare billing, insurance claims, and comprehensive medical documentation within the U.S. medical coding system.
ICD-10 codes and ICD-10-Clinical Modification codes follow a similar structure, and both use alphanumeric characters to represent specific diagnoses, conditions, and medical procedures. The primary difference between the two is in the level of detail. Let’s look at both codes through the lens of a registered dietitian working with a client to provide counseling and nutrition guidance.
There are various print and online sources for accessing ICD-10-CM codes. For example, the American Medical Association (AMA) publishes a printed book that’s updated annually and various other identities provide online resources that make finding the right code easier.
The National Center for Health Statistics (NCHS) is the division of the Centers for Disease Control and Prevention (CDC) responsible for collecting, analyzing, and sharing vital health statistics. They created an ICD-10-CM Browser Tool to make it simple to search for relevant codes. The tool also provides instructions around how to use the codes.
The ICD-10-CM system includes both a Tabular List and an Alphabetic Index to help practitioners navigate and use the system most efficiently.
ICD-10 codes are organized into categories and subcategories. The broad groupings of code are referred to as “chapters,” and each one represents a major category of diseases, conditions, or related health issues.
Chapters are further divided into specific subcategories and individual codes to provide a detailed classification of diseases and conditions. ICD-10 and ICD-10-CM use the same chapters. The difference is that the ICD-10-CM provides more granular subcategories and individual codes to help providers, medical coders, and billing professionals accurately document specific diagnoses and conditions.
Using our example from earlier, ICD-10-CM code Z71.3 falls under Chapter XXI – Factors Influencing Health Status and Contact with Health Services.
Sometimes certain clients don’t fit neatly into a specific condition or disease category. Chapter XVIII in the ICD-10 provides a catch-all category for coding symptoms and signs encountered in an assessment even if a definitive diagnosis hasn’t yet been reached.
The codes in this chapter also play a critical role in gathering data for epidemiological and public health research. By documenting symptoms, signs, and abnormal findings, healthcare professionals contribute to the understanding of emerging health trends and conditions.
External cause codes are referred to as “E” codes.” You add them to the ICD-10-CM code to help tell the full story behind an injury or health condition. Adding extra detail helps insurers make informed decisions regarding coverage and reimbursement. E codes are also useful for morbidity reporting, trend identification, and public health policy information.
To put this in perspective, imagine a holistic physiotherapist is performing an initial assessment. Her client reports the onset of musculoskeletal pain occurred while jogging. The client is experiencing the pain in his lower back and down his leg. This practitioner might use an external cause code (E code) to help contextualize the circumstances that ignited the musculoskeletal pain:
Accurate ICD-10 coding is crucial for ensuring proper reimbursement and maintaining compliance with regulatory requirements. Rather than settling for broad categories, you can drill down to find the code that best matches your client’s condition, symptoms, or procedures.
Navigating the vast ICD-10-CM code library is easier if you search smarter. Start with keywords that accurately describe the patient's condition or diagnosis. The more specific and detailed your keywords, the more precise your code selection will be.
For example, imagine a holistic nutritionist is working with a client who presents with symptoms related to a nutritional deficiency, such as anemia. This nutritionist needs to accurately document the client's condition and treatment in order to bill their insurance provider directly. Here’s how he might search for the correct ICD-10-CM codes.
To remain compliant with Medicare and Medicaid regulations your ICD-10 coding needs to be accurate and up to date. It’s a good idea to familiarize yourself with guidelines for coding and reporting published by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). The document clearly states that the guidelines should be used as a companion document to the official version of the ICD-10-CM as published on the NCHS website.
Internal and external audits can also help identify coding errors and areas for improvement. Regularly review your coding practices and records to reduce compliance risks.
The American Hospital Association (AHA) describes themselves as the national organization that represents and serves all types of hospitals and health care networks. The American Hospital Association's Central Office on ICD-10 provides coding assistance and education through its clearinghouse service. It also publishes a quarterly newsletter, the AHA Coding Clinic for ICD-10-CM and ICD-10-PCS.
The American Academy of Professional Coders (AAPC) is a professional organization in the United States that focuses on medical coding, billing, auditing, compliance, and practice management. The AAPC works to advance the skills and careers of healthcare professionals who work in these fields.
ICD-10 codes are an integral part of healthcare documentation and billing, but there’s no reason they need to stress you out. By understanding what they are, why they matter, and how to access the best resources for navigating the ICD code landscape, you can choose the right ones every time.
Your practice management software can also make it easy for you to reduce repetition and streamlining workflows by saving your codes to a client’s medical history if you routinely see them for the same conditions. See how Practice Better lets you automatically insert your ICD-10 codes into session notes, Superbills, and CMS-1500 forms.
ICD-10 diagnosis codes, also known as an International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM) codes, are unique alphanumeric codes used in US healthcare. These codes represent a specific medical diagnosis, symptom, condition, or reason for a patient's encounter with a healthcare provider. These diagnosis codes serve as a standardized language for recording and communicating health-related information.
You can find a comprehensive list of ICD-10 diagnosis codes in official coding references and resources. These include coding manuals, books, and online databases. Common sources for ICD-10 code look up include the Centers for Disease Control and Prevention (CDC), the American Medical Association (AMA), the American Academy of Professional Coders (AAPC), and the Centers for Medicare & Medicaid Services (CMS). Additionally, many online coding tools and software applications provide access to ICD-10 code sets.
There are thousands of ICD-10-CM codes available to describe a vast range of medical conditions and situations. The most popular codes for medical professionals are less likely to be relevant to health and wellness pros. Here are a few ICD-10-CM codes that are more likely to be used by different wellness pros:
The primary purpose of ICD-10 codes is to standardize the documentation and reporting of medical diagnoses and conditions across the healthcare industry. These codes have several important functions:
ICD-10 codes are organized into a hierarchical structure for systematic classification. This allows healthcare providers to select the most precise code that accurately represents a patient's diagnosis or condition.
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