Hospital Medical Coders Must Switch To The ICD-10-PCS Codes For Billing Purposes

By David Berky
CIO, Find A Code, LLC

For numerous years, United States doctor's offices, medical clinics and hospitals have been using the standard ICD-9-CM on medical forms for inpatient procedures. This code, developed by the World Health Organization (WHO - the "ICD-9") and modified by the use (the "CM"), is used by medical professionals for billing and insurance payments. The procedural codes are also used by health organizations to track mortality rates and medical interventions that are practiced by doctors and health care professionals.

While billers and coders in the United States have been taught to use the ICD-9-CM codes, health care facilities in other countries have started using the International Classification of Diseases tenth revision (ICD-10). ICD-10 was developed in 1993, but only now will coders and health professionals be required to use it, although in a modified form, in the United States.

Basic Information Concerning ICD-10 Procedure Code Set

The ICD-10-PCS shall replace the ICD-9-CM Volume 3 for the reporting of inpatient information. The National Center for Health Statistics asked for and received permission from WHO to create the new code because the old ICD-9-CM ran out of room for assigning new codes to new medical procedures in its classification system. While ICD-9-CM has 13,600 volume of codes, the ICD-10-PCS has 69,000 volume of codes.

So the National Center for Health Statistics had 3M Health Information Management design the new procedure code set for the Centers of Medicare and Medicaid Services (CMS). The new code does not use Latin or eponyms in its medical terminology. The ICD-10 procedure code set uses a seven digit alphanumeric code where each digit is based on the type of medical practice (such as surgery, administration or monitoring), body system, root operation, the body part that received medical attention, the physician's approach, and the type of medical device used, according to SearchHealth IT.

Who Needs To Use the ICD-10-PCS?

All hospitals and payers across the nation must adopt the ICD-10 procedure code set, according to the American Academy of Professional Coders (AAPC). Physicians operating a private practice do not have to use the ICD-10-PCS for their inpatient coding. However inpatient record documentation will differ between ICD-10-PCS and other code sets (CPT, HCPCS) depending on where the patient receives medical attention. So it may be in the physician's best interest for all coders in his or her practice to receive the proper training in ICD-10-PCS in preparation of the change.

Because learning this new medical billing code set will require extensive training, coders and billers are encouraged to get the training early before the implementation comes into effect on October 1st, 2014 when the old ICD-9-CM is replaced. Coders and billers will also be able to use online resources such as for more information on the new ICD-10-PCS codes.

When Will ICD-10 Procedure Code Set Go Into Effect?

For hospitals across the nation, coders and billers will need to begin using the new ICD-10-PCS by October 1st, 2014. Coders and billers will also have to begin submitting their patient claims electronically using the NCPDP Version D.0 and X12 Version 5010 standards. These electronic methods accommodate the new medical codes being implemented.

There will be no grace period given to hospitals to institute the ICD-10 procedure code set in their facilities. All hospitals must become compliant with the new codes before October 1st, 2014. Although there was a delay from the original implementation date in 2013, there should be no further delays with the implementation of these new requirements. Any medical facility required to adopt the new medical code set should make the smooth transition before this time, although the Department of Health and Human Resources will grant extensions beyond the compliance date for legitimate reasons.

What Type Of Training Should Medical Professionals Receive In Preparation For The ICD-10-PCS Code Implementation?

Medical professionals that deal with coding and billing should begin training at least before the end of f the year of 2012. This allows enough time to learn the extensive medical coding information. Health professionals who should take this medical coding training include: physicians, coders, practice managers and billers. These health care professionals will need to take code set training and specialty code set training so that they can determine the correct code to place for certain inpatient medical services.

Because the ICD-10 procedure code set places a high emphasis on anatomy and physiology, all medical professionals seeking to use the new medical code system should consider taking refresher courses into these two types of clinical medical studies.

New Changes Of Coding Will Ensure Better Medical Code Billing

Once medical professionals learn the new ICD-10-PCS coding, it will allow them to become more precise regarding certain medical procedures and methods as this will ensure proper billing practices. While learning anything new, especially something this extensive, can become a challenge, with the right amount of training and with available medical resources such as to use as a cross-reference, billers and coder will find that using this new code set won't be too difficult.

David Berky is CIO of Find A Code, LLC. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding.

Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please contact us.


innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (8-5 Mountain)

request yours today
start today
free subscription

Thank you for choosing Find-A-Code, please Sign In to remove ads.