Pursuant to certain provisions of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act (HIPAA), the Department of Health and Human Services (HHS) published a
Final Rule on January 16, 2009, that mandated nationwide conversion to International Classification of Diseases, Tenth Revision (ICD-10) coding from the current use of International Classification of Diseases,
Ninth Revision (ICD-9). Specifically, the Final Rule modifies the standard medical data code sets for coding diagnoses and inpatient hospital procedures by concurrently adopting the International Classification of
Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, including the official ICD-10-CM guidelines for Coding and Reporting, as maintained and distributed by HHS, and the International
Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding, including the Official ICD-10-PCS Guidelines for Coding and Reporting, as maintained and
distributed by HHS. These new codes replace ICD-9-CM, Volumes 1 and 2, including the Official ICD-9-CM Guidelines for Coding and Reporting and the ICD-9-CM Volume 3, including the Official ICD-9-CM Volume 3
Guidelines for Coding and Reporting for diagnosis and procedure codes, respectively.
ICD-10 Compliance
In January 2009, HHS mandated October 1, 2013 as the single compliance date where all covered entities must begin using the ICD-10 code set.
Since then, HHS published a Final Rule on September 5, 2012, officially changing the ICD-10 compliance date to October 1, 2014. This means that any service or encounter that occurs on or after
October 1, 2014 must be coded using ICD-10 codes.
ICD-10-CM and ICD-10-PCS
ICD-10-Clinical Modification (CM)
- Used for diagnosis coding in all health care settings for reporting conditions, symptoms and diseases for data collection, payment policy, research, and other purposes
- Developed by the National Center for Health Statistics under authorization of World Health Organization (WHO).
ICD-10-Procedure Coding System (PCS)
- Used for procedure coding in the inpatient hospital setting
- Developed by the Centers for Medicare and Medicaid Services (CMS)
Terminology changes in ICD-10-PCS
There will be several definition and terminology changes in the conversion, such as:
ICD-9 Procedure Term |
ICD-10 Procedure Term |
Amputation |
Detachment |
Aspiration |
Drainage |
Cesarean Section |
Extraction of Products of Conception |
Tonsillectomy |
Resection of Tonsils |
ICD-9-CM vol. 1 & 2 and ICD-10-CM Comparison
ICD-9-CM Diagnosis Codes |
ICD-10-CM Diagnosis Codes |
3-5 characters in length |
3-7 characters in length |
Approximately 13,000 codes |
Approximately 68,000 available codes |
First digit may be alpha (E or V) or numeric; Digits 2-5 are numeric |
First digit is alpha; Digits 2-3 are numeric; Digits 4-7 are alpha or numeric |
Limited space for adding new codes |
Flexible for adding new codes |
Lacks detail |
Very specific |
Lacks laterality |
Has laterality |
Example: 453.41 Venous embolism and thrombosis of deep vessels of proximal lower extremity |
Example: I82.411 Embolism and thrombosis of right femoral vein |
ICD-10-CM Format
ICD-9-CM vol. 3 and ICD-10-PCS Comparison
ICD-9-CM Procedure Codes |
ICD-10-PCS Procedure Codes |
3-4 numeric characters in length |
7 alpha-numeric characters in length |
Approximately 3,000 codes |
Approximately 87,000 available codes |
Based upon outdated technology |
Reflects current usage of medical terminology |
Limited space for adding new codes |
Flexible for adding new codes |
Lacks detail |
Very specific |
Lacks body site laterality |
Has body site laterality |
Generic terms for body parts |
Detailed descriptions for body parts |
Lacks description of methodology and approach for procedures |
Provides detailed descriptions of methodology and approach for procedures |
Limits DRG usage |
Allows DRG definitions to better recognize new technologies and devices |
Lacks precision to adequately define procedures |
Precisely defines procedures with detail regarding body part, approach, any device used, and qualifying information. |
Example: 47.01- Laparoscopic appendectomy |
Example: 0DTJ4ZZ - Laparoscopic appendectomy |
ICD-10-PCS Format
More information on ICD-10
Military Health System (MHS) Links
Centers for Medicare and Medicaid Services (CMS) Links
Other Healthcare Industry ICD-10 Links
