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
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