Q: What is ICD-10 CM/PCS?
A: ICD-10 CM/PCS is believed to be the biggest data change ever for the healthcare industry. It replaces the current ICD-9 classification system and affects payers, providers, and vendors. ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision), is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. It is divided into two parts, ICD-10 CM and ICD-10 PCS. ICD-10 CM is used to assign diagnosis codes. ICD-10 PCS is used to assign procedure codes. Beginning October 1, 2014, ICD-10 CM will be used by all providers to assign diagnoses codes to patient visits. ICD-10 PCS will be used only for hospital claims to assign procedure codes to inpatient procedures.
Q: Why does healthcare need the ICD-10 classification system?
A: The current classification system, ICD-9 CM, was developed 30 years ago. Since that time there have been advances in technology and the discovery of additional diseases. ICD-9 is no longer expandable and is unable to accurately describe diagnoses to the level of detail needed for the management of the healthcare system in the 21st century. Because of these shortcomings ICD-10 CM/PCS will be adopted in the United States on October 1, 2014. A number of countries have already adopted ICD-10 CM/PCS. If the United States does not join these countries, the statistics reported for diagnosis codes will be flawed due to the lack of compatible data to compare internationally. The use of an outdated classification system could potentially impact the identification and tracking of new health threats (e.g., SARS, anthrax). Adoption of ICD-10 CM/PCS will aid in the tracking of quality measures, public health surveillance, research, organizational monitoring, health information technology, and reimbursement.
Q: What is the difference between ICD-9 and ICD-10?
A: The implementation of ICD-10 CM/PCS signals an upgrade in the country’s current classification system. There are approximately 17,000 codes available for use with ICD-9 CM. The adoption of ICD-10 CM/PCS will make more than 155,000 codes available and will aid in the implementation of new codes as the evolution of medical technology and medical procedures continues. In effect, ICD-10 is more detailed than ICD-9.
|ICD-9 CM (Diagnosis Codes)||ICD-10 CM (Diagnosis Codes)|
|Consists of 3-5 digits||Consists of 3-7 characters|
|First digit is alpha or numeric (E or V)||First character is always alpha|
|Second-fifth digits are numeric||Second character is numeric|
|Limited space for adding new codes||Flexibility for adding new codes|
|Decimal placed after the first 3 digits||Decimal placed after the third character|
|Alpha characters are not case sensitive||Characters 3-7 can be alpha or numeric|
|17,000 codes||Approximately 68,000 codes|
|ICD -9 CM Volume 3 (Procedure Codes)||ICD-10 PCS (Procedure Codes)|
|ICD-9-CM has 3-4 digits. A decimal is placed after the 2nd digit.||ICD-10 PCS has 7 characters and no decimals|
|All digits are numeric||Each character can be alpha or numeric|
|Numbers 0-9; letters A-H, J-N, P-Z. The letters I and O are not used to avoid confusion with one and zero.|
|All codes must have at least 3 digits||Each code must have 7 characters|
|Generic body parts||Detailed descriptions of body parts|
|3,000 codes||87,000 codes|
Q: ICD Systems Example List
Examples of Systems and Applications That May Use Coded Data
|Encoding software||Case mix systems|
|Medical record abstracting systems||Managed care reporting systems|
|Billing systems||Case management systems|
|DRG groupers||Disease management systems|
|Electronic health record systems||Financial systems|
|Clinical systems||Provider profiling systems|
|Decision support systems||Test ordering systems|
|Computer-assisted coding applications||Clinical reminder systems|
|Registration and scheduling||Performance measure systems|
|Utilization management||Medical necessity software|
|Quality management||Aggregate data reporting systems|
|Computerized Physician Order Entry (CPOE) systems||Registries|
|Clinical protocols||Compliance software|
|Fraud management systems||Patient assessment data sets (e.g., MDS, PAI, OASIS)|
Q: ICD-10 Data Users
Examples of Categories of Data Users Requiring ICD-10 Education
|Coders||Clinical department managers|
|Other HIM professionals||Ancillary departments|
|Quality management||Performance improvement|
|Utilization management||Corporate compliance|
|Accounting||Data quality management|
|Business office||Data security|
|Auditors and consultants||Clinical documentation improvement (CDI) specialists|
|Patient access and registration||Payer contract managers and negotiators|
|Other data users||Registry personnel|