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What is ICD-10?

ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification /Procedure Coding System) consists of two parts:

ICD-10-CM

For diagnosis coding

ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.

ICD-10-PCS

For inpatient procedure coding

ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10 PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding.

Coding under ICD-10-PCS is much more specific and substantially differs from ICD-9-CM procedure coding.

 

Why Transition to ICD-10?

A directive from CMS requiring healthcare providers, payers, clearinghouses, and billing services to comply with the transition to ICD-10 by 1 Oct 2015, which means:

  • All electronic transactions must use Version 5010 standards, which have been required since January 1, 2012. Unlike the older Version 4010/4010A standards, Version 5010 accommodates ICD-10 codes.
  • ICD-10 diagnosis codes must be used for all health care services provided in the U.S., and ICD-10 procedure codes must be used for all hospital inpatient procedures.
 

ICD-10 Facts

  • ICD-10 has 69,000 codes—more than 4 times the 17,000 codes in ICD-9. The additional codes will enable practices to be more specific on claims forms in reporting the care provided to patients.
  • ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims.
  • The medical terminology has been modernized and is consistent throughout the code set.
  • There are codes that have a combination of diagnoses and symptoms, which improves the specificity of the reporting allowing for more information to be reported to completely describe a condition.