• ICD-10-CM and ICD-10-PCS Fact Sheet

    By Cengage Learning Author Mary Jo Bowie

    Why Change?

    • To collect data that is consistent with other countries that report to the World Health Organization
    • To facilitate the reporting of new procedures and diseases

    Federal Registration Announcements

    • The Department of Health and Human Services (HHS) is responsible for overseeing the implementation
    • On January 15, 2009, HHS an announcement was made that the "first" final rule was set for implementation on October 1, 2013
    • On September 5, 2012, HHS announced a one-year delay from October 1, 2013 to October 1, 2014 for the compliance date for the use of ICD-10-CM/PCS.

    History

    • ICD-10 was created and adopted by the World Health Organization (WHO) in 1994
    • Implementation has been slowest in the United States because of HIPAA, resistance by key healthcare players, and the cost of implementation

    Basics

    • ICD-9-CM consists of approximately 13,000 codes
    • ICD-10-CM consists of approximately 68,000 codes
    • ICD-10-PCS consists of 72,920 codes

    COMPARISON

    ICD-9-CM:

    • 3-5 characters
    • First digit is numeric or the letter E or V
    • 2nd-5th characters are always numeric

    ICD-10-CM:

    • 3-7 characters
    • First digit is a letter
    • All letters except U
    • V codes will now be Z codes
    • 2nd and 3rd digits are numeric
    • Digits 4-7 can be alpha or numeric

    ICD-10-PCS vs. CPT/HCPCS

    • CPT and HCPCS will continued to be used for:
      – Physician and other professional services
      – Procedures performed in hospital and freestanding outpatient facilities.

    Format of ICD-10-CM

    xxx.xxxx

    The first three characters represent a category. Codes are then expanded by the use of fourth, fifth, sixth or seventh characters. ICD-10-CM codes can have three to seven characters to be a valid code.

    • 21 Chapters -- first character is a letter, each letter is associated with a particular chapter (except for letter D, used in Chapter II, Neoplasms, and Chapter III, Diseases of the Blood and Blood-forming Organs and the letter H used in chapters 7, Diseases of the eye and adnexa and chapter 8, Diseases of the ear and mastoid process.)
    • There will still be some three-character categories for single conditions ONLY
    • After the decimal point…
      – Subdivision of the three-character categories
      – Codes can be 3, 4, 5, 6 or 7 characters
      – The "x" is used as a placeholder as a 5th-character placeholder at certain 6-character codes

    Format of ICD-10-PCS

    XXXXXXX    

    All ICD-10-PCS codes have 7 characters, and no decimal point is used for PCS codes.

    • ICD-10-PCS is divided into 16 sections that contain tables for code selection.
    • Codes are built from the tables.

    Mapping

    • Know the acronym "GEMs" -- General Equivalence Mappings
    • GEMs are reference mapping tools designed to convert ICD-9-CM/PCS codes to ICD-10-CM/PCS codes

    Impact on the healthcare industry

    • Update on all systems that will contain ICD-10-CM and ICD-10-PCS codes
    • Provider documentation will have to be enhanced for proper code selection
    • Training of staff
    • Vendor software upgrades
    • Superbills/Chargemaster updates needed

    Systems affected by ICD-10-CM/PCS

    • Coding/encoding
    • Financial/billing/DRG
    • ADT/registration
    • Clinical/electronic records
    • QM, RM, compliance, case management
    • Registries
    • Federal/state and local reporting