ICD9CM Codes

Another important system of codes, ICD-9-CM codes, describe a patient's medical condition and are also required by HIPAA. ICD-9-CM codes, which were based on the World Health Organization disease classification system, are the official method of coding diagnoses and procedures associated with hospital utilization in the United States.'112 ICD-9-CM codes, Volumes 1 and 2, are used to report a patient's diagnosis or condition and are used by third-party payors to determine whether the service or product is warranted based on the patient's diagnosis or symptoms. For Medicare billing purposes, ICD-9-CM Volume 3 codes classify hospital inpatient procedures. These codes are also included on Medicare claims and drive the payment methodology for acute care hospital inpatient services. The National Center for Health Statistics and CMS maintain and annually update the ICD-9-CM procedure codes.

Under the Medicare Modernization Act, CMS is required to provide new diagnosis and procedure codes each April, although payments are not adjusted until each October 1.113 This new timeframe facilitates introduction of new technologies and appropriate payments in a more timely manner. The addition of new codes helps ensure that cost data are available and can facilitate creation of a necessary DRG code, when appropriate.

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