ICD-10 Benefits

Why the switch from ICD–9 codes to ICD–10 codes?  While the health care industry has used ICD–9 codes for over 25 years, the code set has not been able to keep up with changes in medicine…newer conditions, and newer ways of treating patients.

The ICD–10 diagnosis code set has been designed to capture much more specific information on the patient’s diagnosis.

The procedure code set will enable hospitals to record much more specific information on procedures performed and devices used.

  1. ICD–10 CM provides tools to describe the condition of the patient in more detail.
  2. ICD-10 PCS provides better information on diagnoses and inpatient hospital procedures
  3. This data is routinely collected on claims
  4. The data can be used to improve many of the functions of the State Medicaid program
  5. ICD-10 CM and ICD-10 PCS will be the new data standard*

* ICD-10 is required for all HIPAA-covered entities for diagnosis coding, and for all inpatient healthcare providers for procedure coding.  ICD-10 is a global standard, which will be implemented in the United States by October 1, 2014. ICD-10 establishes new standards of specificity for description of patient condition and care provided, while also introducing a new reimbursement paradigm to the over $3 trillion U.S. health care economy.  While ICD-10 is a separate mandate, it enables more detailed analysis of healthcare outcomes are under The Patient Protection and Affordable Care Act, also known as “Obamacare.” It will set the standard for data stored in electronic medical records, part of the HITECH Act and Meaningful Use of Electronic Health Records stimulus funds under the American Recovery and Reinvestment Act (ARRA). In the future, data exchanged in health information exchanges (HIEs) will utilize ICD-10 codes.

Read more about ICD-10 consulting services at www.noworldborders.com/icd-10.html

Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See https://www.noworldborders.com/news/ and https://www.noworldborders.com/clients/ for more about the company.

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