ICD-10 Coding

ICD-10-CM vs. ICD-10-PCS

With the transition to ICD-10, in the United States, ICD-9 codes are segmented into ICD-10-CM and ICD-10-PCS codes. The "CM" in ICD-10-CM codes stands for clinical modification; ICD-10-CM codes were developed by the Centers for Disease Control and Prevention in conjunction with the National Center for Health Statistics (NCHS), for outpatient medical coding and reporting in the United States, as published by the World Health Organization (WHO).

The "PCS" in ICD-10-PCS codes stands for the procedural classification system. ICD-10-PCS is a completely separate medical coding system from ICD-10-CM, containing an additional 87,000 codes for use ONLY in United States inpatient, hospital settings. The procedure classification system (ICD-10-PCS) was developed by the Centers for Medicare and Medicaid Services (CMS) in conjunction with 3M Health Information Management (HIM).

ICD-10-CM codes add increased specificity to their ICD-9 predecessors, growing to five times the number of codes as the present system; a total of 68,000 clinical modification diagnosis codes. ICD-10-CM codes provide the ability to track and reveal more information about the quality of healthcare, allowing healthcare providers to better understand medical complications, better design treatment and care, and better comprehend and determine the outcome of care.

ICD-10-PCS is used only for inpatient, hospital settings in the United States, and is meant to replace volume 3 of ICD-9 for facility reporting of inpatient procedures. Due to the rapid and constant state of flux in medical procedures and technology, ICD-10-PCS was developed to accommodate the changing landscape. Common procedures, lab tests, and educational sessions that are not unique to the inpatient, hospital setting have been omitted from ICD-10-PCS.

ICD-10-CM vs. ICD-10-PCS Coding Comparison
ICD-10-CM Codes ICD-10-PCS Codes
  • 3-7 characters make up the CM code
  • Not case sensitive
  • For use in clinical and outpatient settings
  • Approximately 68,000 available codes
  • The first digit either a number or letter (letters “V” and “E” only); all other digits in an ICD-9 code are numbers
  • Decimal point used after first three characters
  • Must be implemented by October 1, 2013
  • 3-7 characters make up the PCS code
  • Not case sensitive
  • Used ONLY for inpatient, hospital settings
  • Approximately 87,000 available codes
  • Each character can be any of 34 possible values the ten digits 0-9 and the 24 letters; the letters “O” and “I” are excluded to avoid confusion with the numbers “0” and “1”
  • NO decimal point ever used in PCS code
  • Must be implemented by October 1, 2013

ICD-10-PCS codes have a multitude of permutations and each of the seven digits play a crucial role in the procedures’ description. The diagram below illustrates the role of each digit for an ICD-10-PCS procedure code.

ICD-10-CM, ICD-10-PCS Coding example ICD 10 Example

The ICD-10-PCS codes add specificity to existing procedure coding, and new procedures can easily be incorporated as medicine, technology, and healthcare continue to advance.

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