Information On ICD-10-PCS And Need For Early Compliance

By Violet Solomon


The ICD-10 stands for international Classification of Diseases and other Related Health Problems, tenth revision. It is used to code diseases and signs, the related symptoms, all the abnormal findings and complaints, the social circumstances and the external causes of injury and diseases. The coding list is published and updated by World Health Organization (WHO) and is used in many other countries other than US. The ICD-10-PCS in particular means the International Classification of Disease 10 Procedure Coding System and consists of both numeric and alphabetical codes ranging from three to seven in total.

The first digit in the code is used to indicate the medical practice section which can be surgery, monitoring, measuring, administration or any other section. The next digits specify the body system, root operation, the body part, the approach used and devices used in that order. The last character (seventh) is used as a qualifying digit. The first three characters are usually so crucial and are stored in the ICD manual to help in reference.

The ICD-10 came as a replacement of the ICD-9 and is set to take effect on October 1, 2014 bringing with it a dramatic change in medical and healthcare sector in general. All the players from federal government, state governments, medical professionals and the insurance firms are set to be affected by this new coding system.

While the ICD-10-PCS are used for in-patient procedures and studies, the same cannot be used when it comes to billing of the radiologist professional components. They are also not applicable for procedures and studies concerning out-patients. The implication is that this coding system describes the procedures that are performed on in-patients but the identical procedures performed on out-patients are still described by the original CPT codes.

The 10th Procedure Coding System is to be used for the in-patient services only. They will not be applicable when it comes to billing the radiologist components. The other significant area where they are not applicable is on the out-patient services. The implication is that a similar procedure performed on in-patient and out-patient is differently coded. For out-patients, CPT is used but ICD-10 is used for in-patients procedures.

As a healthcare provider in US, it is important to be fully compliant with the new coding system long before the October 1, 2014; the date of transition comes. This helps avoid the challenges associated with late attempts to comply such confusion and delays that are likely to be witnessed as there will be a rush from hospitals, surgery centers, clinics, CMS, insurance firms and State Medicaid and other players.

As a healthcare provider, there are no other viable options other than ensuring compliance long before the October I, 2014 date set for new system enrollment. The other options are to outsource the services or retire from the industry all together which does not seem reasonable.

The implementation of ICD-10-PCS is however clouded with rumors and concerns that if confirmed to be true, could prove to be a big game changer in the industry. One of the recurring rumors is the possibility that the coding system will eliminate the so called unspecific codes that have long been used to support payable diagnosis. If confirmed, the CMS claims for code nine and zero may not get paid by insurance companies.




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