What Are ICD-10 Codes?
And how do insurance companies use them to process a claim
ICD-10 codes identify medical diagnoses and help insurance companies understand why the care you were provided was necessary. They work in tandem with CPT Codes and are required on every claim submission. At Better, we validate the accuracy of the ICD-10 codes on every claim we file.
A Guide to ICD-10 Codes
A therapist might decide at intake that a new client is suffering from serious depression. In order to communicate that diagnosis to the client’s health insurance company, it is not enough for a therapist to write that,
“My client is suffering from depression.”
Instead, the therapist is required to identify that diagnosis using a specific code. In this case, if the diagnosis is “Major depressive disorder, recurrent, mild” the provider will use the code F33.0. If the diagnosis is more serious and involves psychotic episodes the code will change to F33.4. In order to bill an insurance company, all providers need to use this coding system that was introduced into US healthcare in the 1980s, although it origins can be traced to 18th century France.
A Very Brief History of ICD Codes
In 1763, the impressively titled Dr. Francois Bossier de Sauvages de Lacroix, a French physician and botanist categorized 10 distinct classes of diseases which were then divided into 2,400 more specific categories. This idea continued to be developed in France until in 1893 a Parisien statistician created an “International List of Causes of Death”.
This classification system continued to develop until, in 1948, it was adopted by the World Health Organization (WHO). The WHO expanded the causes of death listings to include medical diagnoses and changed its name to the International Classification of Diseases (ICD), publishing the first book of codes called IDC-1. Thirty years later the system had evolved through various editions until it reached ICD-9 which introduced 4-digit codes to classify the diagnoses.
In the USA, The Centers for Medicare and Medicaid Services (CMS) realized that the 4-digit codes could be used to help track in-patient hospital billing. Once that connection had been made, linking ICD-9 to medical billing, it was a natual step for health insurance companies to adopt the same system to manage their own claims processing operations.
The Age of ICD-10
In 2015, ICD-9 evolved into ICD-10. You will remember that the major depressive disorder was alpha-numerically coded as F33.0. The introduction of alpha-numeric coding was a significant development in the change from ICD-9 to ICD-10 that occurred in 2015. This increased the number of diagnosis codes from 14,025 to 69,823 and the reasons for this increase are given by the government Centers for Disease Control and Prevention (CDC) on their site as:
To track public health conditions
To improve data for epidemiological research
To measure outcomes and care provided to patients
To make clinical decisions
To identify fraud and abuse
To design payment systems/processing claims
It is the final reason outlined by the CDC that has made ICD-10 so important to healthcare providers, including many of the providers who recommend Better to their clients, because without the correct use of ICD-10 codes, claims will be rejected by health insurance companies.
How to Find ICD-10 Codes
ICD-10 codes are available to healthcare providers in several ways. CMS offers a range of information and resources on ICD-10 codes.
If you need to search for a specific code, and most importantly, a code that is up-to-date, we recommend the website ICD-10 Data which has an amazing range of information and a simple search tool to identify the correct code for your needs.
Finally, CMS publishes an annual reference book, the ICD-10 Code Expert, that contains all the applicable codes for the year.
The Codes Keep Changing
Each year ICD-10 codes change and increase in number. They are becoming more granular as they breakdown diagnoses into more and more precise definitions. These changes take effect annually on October 1 and they are posted on the CMS site. It is very important for all practices to be aware of any code changes in their field because using outdated ICD-10 code on a superbill will mean that the client’s claim will automatically be rejected by insurance.
Better Can Help You
We hope this brief guide proves useful. If you have any billing or coding questions, we are here to help.
Do you need Better brochures for your practice? Request them online or get in touch with your questions at providers@getbetter.co
