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The Difference Between ICD-9 CM and ICD-10 PCS

December 17, 2012

ICD-10The content of healthcare claims is about to change very soon.  ICD-9-CM Volumes I, II and III are going to be replaced by ICD-10-CM and ICD-10-PCS.  For billers in outpatient medical practices, the change from ICD-9 to ICD-10 will mean a complex shift in how medical information is reported to payment.

What is the difference between these two medical coding systems that medical practices rely on to be financially stable?  Firstly, there are many, many more codes.  ICD-9 contains approximately 13,000 codes, a daunting number to deal with already.  ICD-10 will contain a total of approximately 68,000 available codes.  ICD-9 coders and ICD-9 billers are professionally trained and certified to translate medical records into 13,000 codes.  The complexity of assigning codes out of an available pool of 68,000 will provide unique challenges.  It will be like learning a new language.

The structure of ICD-10 codes is greatly expanded and the new codes are capable of reporting data in much greater specificity.  When the Centers for Medicare and Medicaid Services (CMS) mandated the change to be effective in 2014, this was to give the industry time to adapt to the paradigm shift of using unspecified diagnosis codes to detailed codes that can have up to seven characters, as opposed to ICD-9’s five maximum characters.  The granularity of data that ICD-10 codes contain is expected to improve the efficiency of healthcare reimbursement and reduce charges of fraud and abuse.

Unlike ICD-9 codes, which are generally all numeric with the exception of rarely used V- and E- codes, ICD-10 billing will involve an all encompassing alpha-numeric systemization.  The first character of an ICD-10 diagnosis code is always a letter.  It is followed by at least two numbers.  After that, the code can consist of zero to four other characters that can be a combination of numbers and letters.  Every one of these characters communicates specific information in its assigned place.

Medical practices that contract with a professional billing service can expect that the  certified coding staff is proficient in the standards and guidelines that govern the assignment of medical codes for billing purposes.  CMS has reported that it expects the transition for coding professionals already established in their field to be relatively trouble-free.  There will have to be continuing education before, during, and after ICD-10 goes into effect.  CMS’s expectation is that professionals who have already mastered ICD-9 will be able to grasp the underlying coding logic of ICD-10.

Professional medical billers are not waiting for October 1, 2014 for ICD-10 to go into effect.  They are already becoming proficient in this new coding system preemptively.  ICD-10 billing will be a valued skill that no outpatient practice can afford to be without.  Once the new system goes into effect, there will not be time to catch up.  One day, we will billing with ICD-9.  After midnight, we will be billing with ICD-10.  Anyone who has not mastered ICD-10 is going to lose revenue.

ICD-9 does not translate directly to ICD-10.   While the two systems are similar, fundamental structural and directional emphases in the new codes require a comprehensive understanding of the medical documentation, billing, and compliance processes.   

ICD-10 billing will involve being able to identify significant information in the medical record and being able to translate this into highly specific diagnosis codes.  To take one example, the code that describes a fracture of the forearm, S52, will be required to contain the complete number of following characters in order for the diagnosis to be recognized by a payer.  S52.521 is defined as a torus fracture of the lower end of the right radius.  S52.521A will be the code used to describe an initial patient encounter to treat a closed torus fracture of the lower radius.



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