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Scoring a “10” in Casualty Claims Handling

ICD-10 enhances communication between physician and insurer, allowing both to better assess injury severity, causation and proper treatment.

By Michele Hibbert-Iacobacci | Updated on July 01, 2013
Well, it is official: the ICD-10 CM and procedural coding system will be implemented in the United States with dates of service effective October 1, 2014. The introduction of ICD-10 has sparked a great deal of confusion and alarm. Therefore, it is imperative to acknowledge its value and provide reassurance that this is indeed a benefit for patients, as well as the property & casualty (P&C) industry.

ICD-10 introduces more than 68,000 codes for ICD-10-CM, which is used by hospitals and other healthcare facilities to describe and document the patient clinically. Also included are more than 75,000 codes for ICD-10-PCS. The increase in codes can certainly seem overwhelming; however, they were introduced to specifically improve the evaluation of medical care, as well as enable specificity of patient diagnosis, rather than prescribing to a general area of concern. It is this specificity that can be leveraged to better treat patients, by clearly articulating the nature of the illness. For P&C insurers, this significant increase in detail allows us to ensure the patient is being treated in accordance with the nature of the claim. So let’s discuss what all of this means, and why ICD-10 is actually a good thing for those of us working within P&C insurance.

Application In Claims

In the P&C industry, we can no longer use the cloak that we are not subject to the Health Insurance Portability and Accountability Act (HIPPA), and therefore ICD-10 usage is optional. The problem is that legislation introduced since HIPAA was enacted for electronic transaction security—the Health Information Technology for Economic and Clinical Health Act (HITECH)—requires our industry to pay careful attention. In addition, the medical bills are submitted by medical providers, which are covered entities by HIPAA. These covered entities are currently required to submit ICD-10 codes as of October 1st of next year. Thus, if the P&C industry is unable to consume the bills submitted by the covered entities, then the medical bills will be virtually impossible to review and pay appropriately.

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