What are diagnosis codes and what are they used for? Here’s a brief summary.
ICD, which stands for International Classification of Diseases, is a coding system implemented by the World Health Organization (WHO) to represent diagnoses. It was originally developed by the WHO in the 1970s, and periodically new revisions are released. On October 1, 2015, ICD-10 (meaning the 10th revision) became effective and is used in almost every country worldwide, except the United States.
ICD-10 Codes in the United States
The National Center for Health Statistics (NCHS) is responsible for ICD-10 use in the United States. With the permission of the WHO, the NCHS has developed a modification of ICD-10 used only in the United States called ICD-10-CM, with the CM part standing for clinical modification.
Who Uses The Codes in the United States?
These codes are used by physicians, insurance companies, and other healthcare providers to classify and code all diagnoses, symptoms, and procedures in conjunction with hospital care in the United States. Every disease, disorder, injury, infection, and symptom has its own ICD-10-CM code.
What Are The Codes Used For?
These codes are used for everything from processing health insurance claims to tracking disease epidemics and compiling worldwide mortality statistics. According to AAPC, the more granular codes in ICD-10-CM provides multiple benefits, such as the following.
- Better coordinate a patient’s care, both across providers and over time.
- Improve the quality of measurement and reporting.
- Facilitate the detection and prevention of fraud, waste, and abuse.
- Lead to greater accuracy of reimbursement for medical services.
- Improve data capture and analytics for:
- public health surveillance and reporting
- national quality reporting
- research and data analysis
- provide detailed data to enhance healthcare delivery
What Are The Codes for Amyloidosis?
ICD-10-CM allows for approximately 69,000 codes, up from approximately 13,600 in ICD-9-CM. All codes are alphanumeric, beginning with a letter and with a mix of numbers and letters thereafter. Valid codes may have three, four, five, six or seven digits. Specific to amyloidosis, here are the codes.
The first three characters define the category of the disease, disorder, infection or symptom. For example, codes starting with M00-M99 are for diseases of the musculoskeletal system and connective tissue (like rheumatoid arthritis), while codes starting with J00-J99 are for diseases of the respiratory system.
For amyloidosis, the disease is categorized E85 within the E00 – E89 group.
E00 – E89: Endocrine, nutritional and metabolic diseases
Characters in positions 4-6 define the body site, severity of the problem, cause of the injury or disease, and other clinical details. A seventh character is an extension character used for varied purposes such as defining whether this is the initial encounter for this problem, a subsequent encounter, or sequela arising as a result of another condition.
E85.81 Light chain (AL) amyloidosis
E85.82 Wild-type transthyretin-related (ATTR) amyloidosis
E85.89 Other amyloidosis
From medical records to ICD-10-CM Codes to Usable Information
According to Very Well Health, medical coders read medical records, extract the diagnoses from those records, and translate the diagnoses into ICD-10-CM codes. While most coders have software to help them, the process can also be done by hand using books and coding manuals and can vary from health care system to health care system. Whether the medical coder uses software or a book, coding a medical record correctly requires education in the myriad rules used to choose and apply the ICD-10 codes, as well as close attention to detail.
Once the medical record has been coded by the coder, the data can be used in a number of ways.
- The medical biller can send the coded claim to the health insurance company for processing.
- Insurers may use the data to help predict future health care expenditures.
- Researchers may use the data to determine disease prevalence across geographic areas, ages, or in conjunction with other diseases.
In the end, having richer and more granular data provides a number of benefits and brings value to the analysis, processing, and forecasting within the healthcare community.
Now if we can just get amyloidosis diagnosed earlier …
Sources: AAPC, Very Well Health, World Health Organization, Centers for Disease Control and Prevention.