Med Inf 405
Session 9 - Study Questions and Answers
1. What types of information are coded using the ICD-9-CM standard?
Diagnoses (Mortality and Morbidity) as well as procedural data from inpatient & outpatient hospitals, long-term care & home health agencies & other encounters.
2. What are some uses of data coded using ICD-9-CM?
Classifying morbidity & mortality information for statistical purposes;Indexing hospital records by disease
& operations;Reporting diagnoses & procedure for reimbursement; Storing & retrieving data;Determining patterns of care among healthcare providers;Analyzing payments for health services;Performing epidemiological studies, clinical trials, & clinical research;Measuring quality, safety, & efficacy of care;Designing payment systems;Setting health policy;Monitoring resource utilization;Implementing operational & strategic plans;Designing healthcare delivery systems;Improving clinical, financial, & administrative performance;Preventing & detecting healthcare fraud and abuse;Tracking public health and risks.
3. Which standard does the United States use to report mortality statistics to the
WHO?
ICD10-CM
4. What is the purpose of ICD?
The systematic recording, analysis, interpretation, & comparison of mortality & morbidity data collected in different countries.
5. What structural changes are present in ICD-10 when compared to ICD-9?
ICD-10 provides more categories for disease and other health-related conditions than previous versions. ICD-10 has the following general structure (3 volumes, consisting of
21 chapters, with alphanumeric codes). Vol. 1 is codes, Vol. 2 is instructions. Vol 3 is
Alphabetical Index.Changes:Dramatically expanded diagnostic & procedural codes;Field length – systems, interfaces, & databases need to accommodate the larger 7 digit fields;Alphanumeric characters: the first character is a letter, not a number. Systems, interfaces, & databases need to accommodate the alphanumeric characters used in ICD10-PCS;Database size – the ICD10 code set is much larger than ICD-9 (so it requires more storage space);Dual code sets – during the transition to the new code sets, most systems will need to run ICD-10 & ICD-9 & 4010 & 5010 transaction standards;Four more chapters;Separate chapters for diseases of the nervous system, the eye & adnexa, & diseases of the ear and the mastoid process;No separation of codes explaining the external causes of injury & poisoning, & the factors influencing health status & contact with health services from the core classification;ICD-10 codes begin with an alphanumeric character, so chapters begin with a new letter;Chapter content & order are different (i.e, diseases of the skin and subcutaneous tissue & diseases of the musculoskeletal system & connective tissue follow chapters for diseases of the digestive system);Category restructuring & code reorganization (i.e., certain diseases & disorders are classified differently, i.e., streptococcal);Exclusion note expansion and precedence of
other group chapters;Blocks, notes, drug induced conditions, post procedural disorders, complete titles, etiology, & manifestation.
6. How can payers leverage the additional data provided by a greater level of specificity within ICD-10?
Value based purchasing supported by greater level of detail. Payers can drill down into claims data for quality metrics;Fraud detection—ICD-10 reduces ambiguity & misinterpretation by providing more detail. Facilitates use of tools to look for questionable patterns. ICD-9 could be used to hide fraud;Historical claims analysis-> detail allows payers to have better understanding of the prevalence of chronic conditions
& practice patterns.Medical Management -> detail can assist efforts focused on disease, utilization, case management, & policy.
7. What challenges does ICD-10 present for payers?
(1) Older systems may not be able to handle the expanded character sets used in ICD-10;
(2) Staff members will need ICD-10 training in order to develop
