ICD-10-CM/PCS
International Classification of Diseases, 10th Edition
Clinical Modication/Procedure Coding System

  Begin Using October 1, 2013


ICD-10-CM Diagnosis Codes

The International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) will enhance accurate payment for services rendered and facilitate evaluation of medical processes and outcomes.

The new classification system provides significant improvements through greater detailed information and the ability to expand in order to capture additional advancements in clinical medicine.

ICD-10-CM - The diagnosis classification system developed by the Centers for Disease Control and Prevention for use in all U.S. health care treatment settings. Diagnosis coding under this system uses a different number of digits and some other changes, but the format is very much the same as ICD-9-CM.

The U.S. Department of Health and Human Services (HHS) has mandated industry-wide adoption of ICD-10-CM and ICD-10-PCS code sets by Oct. 1, 2013. ICD-10-CMS will affect all components of the healthcare industry. Ambulatory surgery centers (ASCs) will not be affected by ICD-10-PCS unless they are utilizing ICD-9-CM volume 3 for inpatient procedures.

The two major changes in the ICD-9-CM to ICD-10-CM code sets are structure and detail. The codes will move from a numeric five-character size to an alphanumeric seven-character size. At current count, there are approximately 17,000 ICD-9-CM codes and the possibility of 155,000 ICD-10-CM/PCS codes. The codes are far more specific which will allow for greater accuracy.

ICD-10-PCS Procedure Codes

The ICD-10 Procedure Coding System (ICD-10-PCS) is a system of medical classification used for procedural codes. The National Center for Health Statistics (NCHS) received permission from the World Health Organization (WHO), the body responsible for publishing the International Classification of Diseases to create the ICD-10-PCS as a successor to Volume 3 of ICD-9-CM and a clinical modification of the original ICD-10. The original draft was completed in 2000, and is has been updated for 2009. It will follow the same implementation as ICD-10-CM.

The new procedure coding system uses 7 alpha or numeric digits. The current system, ICD-9-CM volume 3 (International Classification of Diseases, 9th Edition, Clinical Modification, does not provide the necessary detail on either patients' medical conditions or on procedures performed on hospitalized patients. ICD-9-CM is 30 years old, has outdated and obsolete terminology, uses outdated codes that produce inaccurate and limited data, and is inconsistent with current medical practice. It cannot accurately describe the diagnoses and inpatient procedures of care delivered in the 21st century. ICD-10-PCS will make the US current with the rest of the developed world.

Diagnostic Information is Not Included in Procedure Description

When procedures are performed for specific diseases or disorders, the disease or disorder is not contained in the procedure code. There are no codes for procedures exclusive to aneurysms, cleft lip, strictures, neoplasms, hernias, etc. The diagnosis codes, not the procedure codes, specify the disease or disorder.

Not Otherwise Specified (NOS) Options are Restricted

ICD-9-CM often provides a "not otherwise specified" code option. Certain NOS options made available in ICD-10-PCS are restricted to the uses laid out in the ICD-10-PCS draft guidelines. A minimal level of specificity is required for each component of the procedure.

Limited Use of Not Elsewhere Classified (NEC) Option

ICD-9-CM often provides a "not elsewhere classified" code option, but because all significant components of a procedure are specified in ICD-10-PCS, there is generally no need for an NEC code option. However, limited NEC options are incorporated into ICD-10-PCS where necessary. For example, new devices are frequently developed, and therefore it is necessary to provide an "Other Device" option for use until the new device can be explicitly added to the coding system. Additional NEC options are discussed later, in the sections of the system where they occur.

Level of Specificity

All procedures currently performed can be specified in ICD-10-PCS. The frequency with which a procedure is performed was not a consideration in the development of the system. Rather, a unique code is available for variations of a procedure that can be performed.

ICD-10-PCS has a seven character alphanumeric code structure. Each character contains up to 34 possible values. Each value represents a specific option for the general character definition (e.g., stomach is one of the values for the body part character). The ten digits 0-9 and the 24 letters A-H,J-N and P-Z may be used in each character. The letters O and I are not used in order to avoid confusion with the digits 0 and 1.

The second through seventh characters mean the same thing within each section, but may mean different things in other sec-tions.

In all sections, the third character specifies the general type of procedure per-formed (e.g., resection, transfusion, fluoroscopy), while the other characters give additional information such as the body part and approach. In ICD-10-PCS, the term "procedure" refers to the complete specification of the seven characters.

Rationale for the Change

To learn more about the reasoning behind the change to ICD-10-CM/PCS please read the excellent article ICD-10-CM Demystified Article - By Wyn Staheli of InstaCode.com.


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