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icd10 - Medical Application Critical Analysis

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ICD-10-CM is a system of classification of morbidity which is a modification of the ICD-10. The -CM stands for clinical modification. It is used to code and classify mortality data from health certificates

The aim of the ICD-10-CM is to serve as a proper statistical classification tool for morbidity reporting in the United States.

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ICD-10-CM and -PCS offer greater detail and increased ability to accommodate new technologies and procedures. The codes have the potential to provide better data for evaluating and improving the quality of patient care. For example, data captured by the code sets could be used in more meaningful ways to better understand complications, design clinically robust algorithms, and track care outcomes. Many quality measures, such as those from HealthGrades and the Agency for Healthcare Research and Quality, rely on ICD-9-CM codes. Increasing the detail and better depicting severity will help clarify the connection between a provider’s performance and the patient’s condition

In addition, ICD-10-CM greatly expands the codes for medical complications and medical safety issues. Complete, accurate, and up-to-date procedure codes will improve data on the outcomes, efficacy, and costs of new medical technology and ensure fair reimbursement policies for the use of this technology. Expanded detail will help payers and providers more easily identify patients in need of disease management and more effectively tailor disease management programs.

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Research by Butler has shown that facilities that lacked physician buy-in for the transition to ICD-10-CM experienced slow adaption to the level of specificity required for documentation.(Butler , 2013) Similarly, Comfort14 reported that criticisms regarding the transition were related to clinical documentation. Bowman further described that in addition to negative impacts on clinical documentation, physician queries also increased since the transition to ICD-10-CM. Other studies reflected on the benefits of adequate training and buy-in. In particular, Comfort reported that minimal disruption during the transition was due to a long-term training program including dual coding and further acknowledged the support of leadership buy-in to the ICD-10-CM system as a “monumental” success factor

Previous studies have focused on the increased specificity in ICD-10-CM for fully capturing and monitoring public outbreaks, as well as for research, reporting, and surveillance use, compared with ICD-9-CM.23 A study found ICD-10-CM to be more specific in capturing public health diseases than ICD-9-CM for the National Vital Statistics Report's top 10 causes of morbidity.

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As can be seen, most of the physicians we talked with were ready to embrace the change to ICD-10-CM/PCS and looked forward to ways in which they could mine new types of data that could help them with their patients and their practices. Crosswalks that are specific to physician subspecialties are needed. Physicians said that they do not need all of the coded information and crosswalks that are now available, but they do want resources that are specific to their specialty and can minimize the amount of time it takes them to document, code, and bill appropriately so that they get the correct reimbursement for their services.

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Verhovshek John. “ICD-11 Is (Not) Coming.” March 21, 2018

Jannenga Heidi. “How Soon Until the US Switches to ICD-11?” December 17, 2015 Comfort Angie. “ICD-10-CM/PCS: Two Years and Counting.” Journal of AHIMA. 2017;88(no. 9):60–63.

Bowman Sue A. “Look Back on the ICD-10 Transition: Crisis Averted or Imaginary?” Journal of AHIMA, 2016;87(no. 8):24.

Averill Richard. “Commentary: The ICD-10 Saga—Lost Years and Hard Lessons.” Journal of AHIMA. 2016

Butler Mary. “Analyzing Eight Months of ICD-10.” Journal of AHIMA. 2016;87(no. 6):15–22.

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