Coding Corner: The Future of Coding - ICD-10-CM and ICD-10-PCS

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and The International Classification of Diseases, Tenth Revision, Procedure Classification System(ICD-10-PCS).

Currently 138 countries have implemented ICD-10-CM for mortality reporting and 99 countries have implemented it for morbidity reporting, with the United States still using the ICD-9-CM system it is difficult to compare our health data with international data. Although, the United States implementation of either one of these systems has not been announced, draft legislation contains a provision to implement ICD-10. Implementation will be based on the process for adoption of standards under the Health Insurance Portability and Accountability Act (HIPAA). There will be a two-year implementation window once the final notice to implement has been published in the Federal Register.

<p.If passed, HR 4157, The Health Information Technology Promotion Act, would require the Secretary to implement ICD-10-CM and ICD-10-PCS on October, 1, 2009.


  • Improvements to the quality of care and patient safety.
  • Fewer rejected or questionable reimbursement claims.
  • Improved information for disease management.
  • More accurate reimbursement rates for emerging technologies.
  • Better understanding of the value of new procedures.

Major changes in the ICD-10-CM include:

  • 21 chapters (ICD-9 has 17).
  • The E-codes and the V-codes are incorporated within the new system rather than the current supplementary classifications.
  • Identification of trimesters to obstetrical codes.
  • Expanded diabetes, injury, alcohol/substance abuse, and postoperative complications.
  • Ability to report laterality (to specify whether a medical condition occurred on the right or left side).
  • Standard definitions for “excludes” notes.
  • Combination diagnosis/symptoms codes.
  • Identification of initial encounter, subsequent encounter, and sequelae of injuries.
  • Expanded external causes of injuries.
  • Improved clinical detail.
  • Addition of a sixth character.
  • Addition of a seventh character extension in some chapters. (ICD-9, max 5).

The ICD-10-CM is published by the World Health Organization (WHO) you may find the guidelines for the use of this classification in the Official Coding and Reporting Guidelines of ICD-10-CM (

Major changes in the ICD-10-PCS include:

  • 15 sections in the ICD-10-PCS with almost eighty eight thousand codes compared to the maximum of ten thousand codes of our present system.
  • Consists of alphanumeric codes rather than all numeric codes. The current system contains a maximum of four numbers with a decimal point, the new system has a maximum of seven characters with no decimal point.
  • The includes and excludes notes are not included in the new system.
  • All codes have a unique definition
  • Ability to aggregate codes across all essential components of a procedure.
  • Extensive flexibility.
  • New procedures and technologies are easily incorporated.
  • Code expansions do not disrupt systematic structure.
  • Limited use of NOS and NEC categories.
  • Terminology is precisely defined and used consistently across all codes.
  • No diagnostic information is included in the code.
  • Increases accuracy and efficiency by being able to recognize and report the procedures performed.

For detailed information on the development of ICD-10-PCS visit the CMS Web site:

As our world grows smaller the need for accurate health data will benefit us all.