Millions of people receive medical treatment for injuries every day. Injured persons often focus on their pain and the implications of their injuries but don’t always consider the medical paperwork resulting from their treatment.
The International Classification of Diseases (ICD) codes attached to medical paperwork impact treatment and billing. Patients may need to learn about ICD-10 codes when they need medical care.
What are ICD-10 codes?
The origins of ICD codes stretch back to the 19th century. Statistician Jacque Bertillon introduced the Bertillon Classification of Causes of Death in 1891. These codes made it easier to develop statistical information about the various causes of death. The American Public Health Association recommended that the U.S. adopt Bertillon’s system in 1898.
The Centers for Disease Control and Prevention’s (CDC’s) National Center for Health Statistics expanded Bertillon’s system, producing a clinical modification known as ICD-10-CM. The Centers for Medicare and Medicaid Services (CMS) developed the ICD-10-PCS, the procedure coding system.
Who uses ICD-10 codes?
The World Health Organization (WHO) states that approximately 117 countries use ICD codes to report death statistics. Medical professionals, health information managers, and medical billers use the ICD-10 system every day. Insurance companies, CMS, and government organizations may also use ICD-10 codes when processing claims or making healthcare decisions.
Personal injury attorneys may refer to ICD-10 codes when filing client lawsuits. A car accident attorney will ensure the hospital used the correct codes when filing insurance claims to prevent complications with their client’s case. Suppose the ICD-10 code for motor vehicle collision is used instead of the ICD-10 code for motor vehicle accident during pregnancy. In that case, a pregnant client may have difficulty pursuing compensation for complications with their pregnancy stemming from the accident.
Why would a patient need to understand ICD-10 codes?
Typically, ICD-10 codes appear on the billing information sent to CMS or your insurance company. Healthcare providers also use ICD-10 codes when requesting pre-approval for future medical services.
You might need to look up ICD codes to ensure they’re accurate if your insurance company denied a claim or pre-approval request. ICD-10-CM and ICD-10-PCS codes have multiple characters. A medical biller or claims processor can mistakenly enter the wrong code, leading to financial complications if the incorrect code prompts your insurer to deny your claim.
Understanding ICD-10 Codes
Anyone who doesn’t use ICD-10 codes in their career may find the codes confusing. Fortunately, ICD-10 codes use a categorization system, enabling them to pass on specific information with a relatively short code.
Suppose you’re in an automobile accident. Your ICD-10 code will depend on your status and the nature of your injuries. Consequently, there isn’t one single “ICD-10 code for motor vehicle accident” for every MVA. Some MVAs would receive an “ICD-10 code for motor vehicle accident unspecified,” or a code identifying the type of accident, such as an “ICD-10 code for car driver injured in rollover accident.”
When creating an ICD-10 code for motor vehicle accident with injury, the first thing to consider is whether to use an S, T, or V code.
ICD S Codes: Localized Injury
ICD-10-CM S codes identify the area of your body where you sustained the injury, the injured body part, and details about the injury. Each S code begins with a correlation to the region where you sustained the injury. For example, neck injuries would receive a code that’s first two digits are S1. The third digit in the code adds information about the injuries sustained. Suppose you had a cut on your neck. Your code would be S11.
ICD T Codes
T codes identify injuries affecting multiple body parts. Examples include frostbite, poisonings, or multiple injuries. T07 refers to multiple body injuries, while T33 and T34 are codes for injuries from frostbite.
ICD V Codes: Transportation Accidents
V codes clarify the mode of transportation the person was using when injured. Since 0 identifies the person as a pedestrian, pedestrians would receive a code beginning with V0. Your pedestrian accident attorney will want to ensure your ICD codes are correct while negotiating settlements with insurance companies and at-fault drivers. A car accident lawyer would want to ensure that a car passenger received a V4 code.
The third digit in V codes offers information about the type of accident. If a driver struck a deer, the third digit would be 0. If the vehicle collided with a train, the third digit would be 5.
V codes receive a fourth digit that clarifies the person’s role. The “ICD-10 code for motor vehicle accident driver” would have a 0 for a non-traffic accident or 5 for a traffic accident. Non-traffic accidents are accidents that don’t occur while the vehicle operates on a roadway.
Who assigns ICD-10 codes?
Medical facilities and healthcare providers assign ICD-10 codes when patients receive treatment. The ICD-10 codes can identify the patient’s diagnosis, the cause of their medical issues, and the treatment provided. These codes appear on paperwork processed by insurance companies. Insurance companies use these codes to determine whether to authorize payment for treatment.
What are the benefits of using ICD-10 codes?
ICD-10 codes bypass language barriers. With a few digits, insurance companies, statisticians, and medical professionals have access to clear medical information without using translators.
Using a shared, standardized system ensures that people making healthcare decisions operate with the same information. The codes clarify causes of death or illness, enabling healthcare providers to identify viral outbreaks and pandemics. ICD-10 codes ensure decision-makers have faster access to accurate information about health trends, enabling them to act promptly when health concerns arise.
How can you look up ICD-10 codes?
CMS provides access to several resources explaining ICD codes, including documents with commonly used codes. You can also learn about specific ICD codes and find codes via Find-A-Code.
Sources
ICD-10-CM Diagnosis Codes. (2022).
ICD-10 Resources. (2022).
Importance of ICD. (2022).
Torrey, Trisha. (2022). ICD 10 Codes and How To Look Them Up.