The ICD-10 Procedure Coding System (ICD-10-PCS) is a US system of medical classification used for procedural coding. The Centers for Medicare and Medicaid Services, the agency responsible for maintaining the inpatient procedure code set in the U.S., contracted with 3M Health Information Systems in 1995 to design and then develop a procedure classification system to replace Volume 3 of ICD-9-CM. ICD-9-CM contains a procedure classification; ICD-10-CM does not. ICD-10-PCS is the result. ICD-10-PCS was initially released in 1998. It has been updated annually since that time. [1] Despite being named after the WHO's International Classification of Diseases, it is a US-developed standard which is not used outside the United States. [2]
Each code consists of seven alphanumeric characters. The first character is the 'section'. The second through seventh characters mean different things in each section. Each character can be any of 34 possible values the ten digits 0-9 and the 24 letters A-H, J-N and P-Z may be used in each character. The letters O and I are excluded to avoid confusion with the numbers 0 and 1. [3] There are no decimals in ICD-10-PCS [4]
Of the 72,081 codes in ICD-10-PCS, 62,022 are in the first section, "Medical and surgical". [5]
| Character 1 | Character 2 | Character 3 | Character 4 | Character 5 | Character 6 | Character 7 |
|---|---|---|---|---|---|---|
| 0 Medical and Surgical | Body System 0 Central nervous system; 1 Peripheral nervous system; 2 Heart and Great vessels; 3 Upper arteries; 4 Lower arteries; 5 Upper veins; 6 Lower veins; 7 Lymphatic and Hemic system; 8 Eye; 9 Ear, Nose, Sinus; B Respiratory System; C Mouth and Throat; D Gastrointestinal system; F Hepatobiliary System and Pancreas; G Endocrine system; H Skin and Breast; J Subcutaneous tissue; K Muscles; L Tendons; M Bursae and Ligaments; N Head and Facial bones; P Upper bones; Q Lower bones; R Upper joints; S Lower joints; T Urinary system; U Female reproductive system; V Male reproductive system; W Anatomical regions, General; X Anatomical regions, Upper extremities; Y Anatomical regions, Lower extremities | Root Operation see below | Body Part | Approach 0 Open; 3 Percutaneous; 4 Percutaneous Endoscopic; 7 Via Natural or Artificial Opening; 8 Via Natural or Artificial Opening Endoscopic; F Via Natural or Artificial Opening Endoscopic with Percutaneous Endoscopic Assistance; X External | Device | Qualifier |
| 1 Obstetrics | 10 Pregnancy | 102 Change; 109 Drainage; 10A Abortion; 10D Extraction; 10E Delivery; 10H Insertion; 10J Inspection; 10P Removal; 10Q Repair; 10S Reposition; 10T Resection; 10Y Transplantation | Body Part | Approach | Device | Qualifier |
| 2 Placement | 2W Anatomical Regions; 2Y Anatomical Orifices | Root Operation 2?0 Change; 2?1 Compression; 2?2 Dressing; 2?3 Immobilization; 2?4 Packing; 2?5 Removal; 2?6 Traction | Body Region/Orifice | Approach | Device | Qualifier |
| 3 Administration | 30 Circulatory; 3CIndwelling Device; 3E Physiological Systems and Anatomical Regions | Root Operation | Body System/Region | Approach | Substance | Qualifier |
| 4 Measurement and Monitoring | 4A Physiological Systems; 4B Physiological Devices | Root Operation | Body System | Approach | Function | Qualifier |
| 5 Extracorporeal Assistance and Performance | 5A Physiological Systems | Root Operation | Body System | Duration | Function | Qualifier |
| 6 Extracorporeal Therapies | 6A Physiological Systems | Root Operation 6A0 Atmospheric control; 6A1 Decompression; 6A2 Electromagnetic therapy; 6A3 Hyperthermia; 6A4 Hypothermia; 6A5 Pheresis; 6A6 Phototherapy; 6A7 Ultrasound therapy; 6A8 Ultraviolet light therapy; 6A9 Shock wave therapy | Body System | Duration | Qualifier | Qualifier |
| 7 Osteopathic | 7W | 7W0 | Body Region | Approach | Method | Qualifier |
| 8 Other Procedures | 8C Indwelling Device; 8E Physiological Systems and Anatomical Regions | Root Operation | Body Region | Approach | Method | Qualifier |
| 9 Chiropractic | 9W | 9WB | Body Region | Approach | Method | Qualifier |
| B Imaging | Body System 0 Central Nervous System; 2 Heart; 3 Upper Arteries; 4 Lower Arteries; 5 Veins; 7 Lymphatic System; 8 Eye; 9 Ear, Nose, Mouth and Throat; B Respiratory System; D Gastrointestinal System; F Hepatobiliary System and Pancreas; G Endocrine System; H Skin, Subcutaneous Tissue and Breast; L Connective Tissue; N Skull and Facial Bones; P Non-Axial Upper Bones; Q Non-Axial Lower Bones; R Axial Skeleton, Except Skull and Facial Bones; T Urinary System; U Female Reproductive System; V Male Reproductive System; W Anatomical Regions; Y Fetus and Obstetrical | Root Type | Body Part | Contrast 0=high osmolar contrast; 1=low osmolar contrast; z=other contrast | Qualifier | Qualifier |
| C Nuclear medicine | Body System 0 Central Nervous System; 2 Heart; 5 Veins; 7 Lymphatic and Hematologic System; 8 Eye; 9 Ear, Nose, Mouth and Throat; B Respiratory System; D Gastrointestinal System; F Hepatobiliary System and Pancreas; G Endocrine System; H Skin, Subcutaneous Tissue and Breast; P Musculoskeletal System; T Urinary System; V Male Reproductive System; W Anatomical Regions | Root Type | Body Part | Radionuclide | Qualifier | Qualifier |
| D Radiation oncology | Body System 0 Central and Peripheral Nervous System; 7 Lymphatic and Hematologic System; 8 Eye; 9 Ear, Nose, Mouth and Throat; B Respiratory System; D Gastrointestinal System; F Hepatobiliary System and Pancreas; G Endocrine System; H Skin; M Breast; P Musculoskeletal System; T Urinary System; U Female Reproductive System; V Male Reproductive System; W Anatomical Regions | Root Type | Body Part | Modality Qualifier | Isotope | Qualifier |
| F Physical rehabilitation and Diagnostic Audiology | F/0 Rehabilitation; F/1 Diagnostic Audiology | Root Type | Body System & Region | Type Qualifier | Equipment | Qualifier |
| G Mental health | GZ None | Root Type GZ1 Psychological tests; GZ2 Crisis intervention; GZ3 Medication management; GZ5 Individual psychotherapy; GZ6 Counseling; GZ7 Family psychotherapy; GZB Electroconvulsive therapy; GZC Biofeedback; GZF Hypnosis; GZG Narcosynthesis; GZH Group psychotherapy; GZJ Light therapy | Type Qualifier | Qualifier | Qualifier | Qualifier |
| H Substance abuse Treatment | HZ None | Root Type | Type Qualifier | Qualifier | Qualifier | Qualifier |
| X New Technology |
For medical/surgical, these are the root operation codes:
00 alteration; 01 bypass; 02 change; 03 control; 04 creation; 05 destruction; 06 detachment; 07 dilation; 08 division; 09 drainage; 0B excision; 0C extirpation; 0D extraction; 0F fragmentation; 0G fusion; 0H insertion; 0J inspection; 0K map; 0L occlusion; 0M reattachment; 0N release; 0P removal; 0Q repair; 0R replacement; 0S reposition; 0T resection; 0U supplement ; 0V restriction; 0W revision; 0X transfer; 0Y transplantation
They can be grouped into several categories: [5]
| Region | Code |
|---|---|
| Head | 0 |
| Cervical | 1 |
| Thoracic | 2 |
| Lumbar | 3 |
| Sacrum | 4 |
| Pelvis | 5 |
| Lower extremities | 6 |
| Upper extremities | 7 |
| Rib cage | 8 |
| Abdomen | 9 |
ICD-10-PCS (P1690) (see uses )The International Classification of Diseases (ICD) is a globally used medical classification used in epidemiology, health management and for clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating authority for health within the United Nations System. The ICD is originally designed as a health care classification system, providing a system of diagnostic codes for classifying diseases, including nuanced classifications of a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. This system is designed to map health conditions to corresponding generic categories together with specific variations, assigning for these a designated code, up to six characters long. Thus, major categories are designed to include a set of similar diseases.
Diagnosis-related group (DRG) is a system to classify hospital cases into one of originally 467 groups, with the last group being "Ungroupable". This system of classification was developed as a collaborative project by Robert B Fetter, PhD, of the Yale School of Management, and John D. Thompson, MPH, of the Yale School of Public Health. The system is also referred to as "the DRGs", and its intent was to identify the "products" that a hospital provides. One example of a "product" is an appendectomy. The system was developed in anticipation of convincing Congress to use it for reimbursement, to replace "cost based" reimbursement that had been used up to that point. DRGs are assigned by a "grouper" program based on ICD diagnoses, procedures, age, sex, discharge status, and the presence of complications or comorbidities. DRGs have been used in the US since 1982 to determine how much Medicare pays the hospital for each "product", since patients within each category are clinically similar and are expected to use the same level of hospital resources. DRGs may be further grouped into Major Diagnostic Categories (MDCs). DRGs are also standard practice for establishing reimbursements for other Medicare related reimbursements such as to home healthcare providers.
The Major Diagnostic Categories (MDC) are formed by dividing all possible principal diagnoses into 25 mutually exclusive diagnosis areas. MDC codes, like diagnosis-related group (DRG) codes, are primarily a claims and administrative data element unique to the United States medical care reimbursement system. DRG codes also are mapped, or grouped, into MDC codes.
Medical billing is a payment practice within the United States healthcare system. The process involves the systematic submission and processing of healthcare claims for reimbursement. Once the services are provided, the healthcare provider creates a detailed record of the patient's visit, including the diagnoses, procedures performed, and any medications prescribed. This information is translated into standardized codes using the appropriate coding system, such as ICD-10-CM or Current Procedural Terminology codes—this part of the process is known as medical coding. These coded records are submitted by medical billing to the health insurance company or the payer, along with the patient's demographic and insurance information. Most insurance companies use a similar process, whether they are private companies or government sponsored programs. The insurance company reviews the claim, verifying the medical necessity and coverage eligibility based on the patient's insurance plan. If the claim is approved, the insurance company processes the payment, either directly to the healthcare provider or as a reimbursement to the patient. The healthcare provider may need to following up on and appealing claims.
A medical classification is used to transform descriptions of medical diagnoses or procedures into standardized statistical code in a process known as clinical coding. Diagnosis classifications list diagnosis codes, which are used to track diseases and other health conditions, inclusive of chronic diseases such as diabetes mellitus and heart disease, and infectious diseases such as norovirus, the flu, and athlete's foot. Procedure classifications list procedure code, which are used to capture interventional data. These diagnosis and procedure codes are used by health care providers, government health programs, private health insurance companies, workers' compensation carriers, software developers, and others for a variety of applications in medicine, public health and medical informatics, including:
A curette is a surgical instrument designed for scraping or debriding biological tissue or debris in a biopsy, excision, or cleaning procedure. In form, the curette is a small hand tool, often similar in shape to a stylus; at the tip of the curette is a small scoop, hook, or gouge. The verb to curette means "to scrape with a curette", and curettage is treatment that involves such scraping.
The Current Procedural Terminology (CPT) code set is a procedural code set developed by the American Medical Association (AMA). It is maintained by the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes. New editions are released each October, with CPT 2021 being in use since October 2021. It is available in both a standard edition and a professional edition.
Procedure codes are a sub-type of medical classification used to identify specific surgical, medical, or diagnostic interventions. The structure of the codes will depend on the classification; for example some use a numerical system, others alphanumeric.
ICD-9-CM Volume 3 is a system of procedural codes used by health insurers to classify medical procedures for billing purposes. It is a subset of the International Statistical Classification of Diseases and Related Health Problems (ICD) 9-CM. Volumes 1 and 2 are used for diagnostic codes.
The International Classification of Health Interventions (ICHI) is a system of classifying procedure codes being developed by the World Health Organization (WHO). It is currently available as a beta 3 release. The components for clinical documentation are stable. The component on public health interventions is in the process of being finalized. Updates on development and status of the classification are listed on WHO home page.
Surgical pathology is the most significant and time-consuming area of practice for most anatomical pathologists. Surgical pathology involves gross and microscopic examination of surgical specimens, as well as biopsies submitted by surgeons and non-surgeons such as general internists, medical subspecialists, dermatologists, and interventional radiologists.
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. Work on ICD-10 began in 1983, became endorsed by the Forty-third World Health Assembly in 1990, and was first used by member states in 1994. It was replaced by ICD-11 on January 1, 2022.
Severity of illness (SOI) is defined as the extent of organ system derangement or physiologic decompensation for a patient. It gives a medical classification into minor, moderate, major, and extreme. The SOI class is meant to provide a basis for evaluating hospital resource use or to establish patient care guidelines.
The Healthcare Cost and Utilization Project is a family of healthcare databases and related software tools and products from the United States that is developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ).
Current Dental Terminology (CDT) is a code set with descriptive terms developed and updated by the American Dental Association (ADA) for reporting dental services and procedures to dental benefits plans. Prior to 2010 many of the codes were published by Centers for Medicare and Medicaid Services (CMS) as HCPCS D-codes under arrangement with the ADA. Ownership and copyright of CDT remained with the ADA. In 2010 the ADA ended the CMS distribution of CDT codes, which can now be purchased from the ADA.
The Healthcare Common Procedure Coding System is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT).
OPS, the Operationen- und Prozedurenschlüssel is the German modification of the International Classification of Procedures in Medicine (ICPM). For German hospitals it is currently the official coding system for medical procedures. Apart from its use for clinical controlling and performance statistics it is a basis for inpatient claims processing within the German Diagnosis-related Groups (G-DRG) system. Yearly OPS releases are produced by DIMDI. Besides OPS, G-DRG also requires disease codes based on ICD-10-GM is.
Intelligent Medical Objects (IMO) is a privately held company specializing in developing, managing and licensing medical vocabularies. IMO partners with various health care organizations, medical content providers and EHR developers.
The ICD-10 Clinical Modification (ICD-10-CM) is a set of diagnosis codes used in the United States of America. It was developed by a component of the U.S. Department of Health and Human services, as an adaption of the ICD-10 with authorization from the World Health Organization. In 2015, ICD-10-CM replaced ICD-9-CM as the federally mandated classification. Annual updates are provided.
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