U.S. Medical Coding Updated and Required by Providers as of Oct. 1

Pinnacle Claims Management - US Medical Coding UpdatedOn October 1, the ICD medical code – called ICD-10 –was launched and now must be used for all health treatment reporting.   The ICD medical code is used to report medical diagnoses and inpatient procedures, and the change may impact PCMI plan participants.   What is ICD-CM?    The ICD-CM code is the official medical coding system used by physicians, hospitals and allied health workers to indicate diagnosis and/or procedures for health treatments of all p

On October 1, the ICD medical code - called ICD-10 –was launched and now must be used for all health treatment reporting.   The ICD medical code is used to report medical diagnoses and inpatient procedures, and the change may impact PCMI plan participants.  

What is ICD-CM?  

The ICD-CM code is the official medical coding system used by physicians, hospitals and allied health workers to indicate diagnosis and/or procedures for health treatments of all patient encounters.  The ICD-10 is the latest revision to the medical code and is required by the Department of Health and Human Services to comply with recent Health Insurance Portability Accountability Act (HIPAA) reporting standards.  All claims for dates of service on or after October 1, 2015 must be submitted using the new ICD-10 medical codes.  

Some key differences between ICD-9, the earlier version of the medical code, and ICD-10 are that the newer codes have 7 digits (as compared to 3-4 digits in ICD-9) and there are now over 150,000 diagnoses and procedure codes as compared to 18,000 from before. The increased number of digits and medical codes can now capture more specific diagnosis and procedures, which reflects a more modern view of treatment today. 

Until the health industry has fully converted to using the ICD-10 code, PCMI employer groups may have participants that experience delays or claim denials. These incidents will result from providers not submitting claims using the new ICD-10 coding system.  

To ensure that the transition is smooth for all our PCMI clients, please be assured that our systems are set up to accommodate the new ICD-10 codes and that we are working closely with our network providers to make sure they are submitting claims using the new medical codes. However, should claims delays or denials occur, please ask your employees to contact our customer service team and we will investigate and find a solution to the issue. You can call our Customer Service Department at (800) 649-9121, Monday through Friday, 7 a.m. to 5:30 p.m. Pacific Time.