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Summer 2007


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.

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.

Benefits

  • 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 (www.cdc.gov/nchs/icd9.htm).

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: www.cms.hhs.gov.

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