When it comes to the payment of patient claims forms, insurance companies typically reimburse for any procedures and treatments carried out. According to the good folk at Find-A-Code.com, these treatments are translated into what are known as CPT (Current Procedural Terminology) codes by medical coders. After this, a bill is prepared by the biller and sent to the relevant payer for reimbursement. But why then are diagnosis codes needed? After all, if the payer has the information about what treatments the patient had, why do they need to know what the diagnosis was?
What are Diagnosis Codes?
It is easy to assume that those companies checking claims forms would not care what the patient diagnosis is, but the reason diagnosis codes must be included in a claim form is to provide more information about why the treatments were carried out. This information is vital when it comes to prompt payment.
Diagnosis codes are also known as International Classification of Diseases (ICD) codes. Although the current system being used is the tenth revision (ICD-10 codes), ICD-11 codes were introduced by the World Health Organization (WHO) in January 2022 and are expected to be fully adopted by the U.S. by 2025.
ICD-10 codes are alphanumeric codes that healthcare providers and insurance companies all over the world use to classify diseases, injuries, and their symptoms.
Why are ICD Codes So Important?
As mentioned above, diagnosis codes provide information about why certain treatments are performed. But more than that, these codes can, for example, offer insight via statistical information about why certain populations are affected by disease. This allows for better data used for the study of specific diseases and their patterns. According to the WHO, ICD is important because it “allows the world to compare and share data in a consistent and standard way – between hospitals, regions and countries and over periods of time”.
The use of diagnosis codes helps to minimize errors and has an impact on patient management. Because medical coding is a universal language, the use of them removes any ambiguity and allows healthcare professionals to make informed decisions regarding their patient’s treatment.
Insurance providers use the diagnosis codes to cross-check the treatments provided to ensure that there are no errors and so that reimbursement is quick and accurate.
Why are New Codes Being Introduced?
The new ICD-11 coding system is being introduced to address the gaps in the ICD-10 coding system and includes new methods and discoveries. It contains new behavioral, mental, and neurodevelopmental conditions such as mood disorders, obsessive compulsive disorders, and personality disorders.
The idea behind the introduction of the new ICD-11 diagnosis codes is that they are clearer and more specific. There will be 55,000 unique codes in ICD-11, compared with 14,000 in ICD-10. There are translations into 50 languages, and they will include guidance for different cultures, allowing for dual coding of traditional medicine. Furthermore, on the back of the recent global Covid-19 pandemic, the ICD-11 coding system includes emergency pandemic codes as well.
Summary
Diagnosis codes, or ICD codes as they are known, are used by medical professionals and insurance companies to correctly identify diseases and injuries, and the symptoms associated with them. Diagnosis codes are recorded on patient files so that informed decisions can be made regarding their care and so that insurance companies can understand why certain procedures and treatments were performed.
Furthermore, diagnosis codes allow for statistical data to be shared across the world, giving a greater understanding of the types of conditions that affect different populations. With this information, scientists can improve population health and inform policy decisions.
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