What impact will ICD-10-CM and ICD-10-PCS have on fraud and abuse prevention and detection?

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What impact will ICD-10-CM and ICD-10-PCS have on fraud and abuse prevention and detection?

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The use of ICD-10-CM and ICD-10- PCS may help reduce the opportunities for fraud and improve fraud detection capabilities. Field testing has shown that ICD-10’s greater specificity results in improved data accuracy and coding due to the level of detail in the code descriptors. The improved logic and increased specificity in ICD-10 will facilitate the development of sophisticated edit tools for detection of questionable patterns and suspected fraud, whereas continued use of ICD-9-CM inhibits the development of computer-assisted coding systems that can reduce fraud. The report of the anti-fraud study conducted by the Office of the National Coordinator for Health Information Technology (ONC) is available at http://www.hhs.gov/healthit/documents/ReportOnTheUse.pdf.

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