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Experience. Integrity. Advocacy.

Inpatient Procedure Coding: Comparing ICD-9 Volume 3 and ICD-10-PCS

Since 1979, reporting procedures for hospital inpatient services has been done using Volume 3 of ICD-9. However, this system not only is outdated, given our current medical knowledge and available technologies, but IC9 Volume 3 is unable to be expanded further to identify specific levels of detail needed to classify procedure codes.

In 1992 the Centers for Medicare and Medicaid Services (CMS) funded a project with 3M Health Information Systems to develop the ICD-10-Procedure Coding System (PCS). ICD-10-PCS is a multi-axial, seven-character, alphanumeric structure providing the specificity needed for thorough inpatient coding.  Below are some of the distinct differences:

ICD-9 VOLUME 3 ICD-10-PCS
3-4 numbers in length 7 alphanumeric characters in length
Approximately 3,000 codes Approximately 87,000 codes
Based on outdated technology Reflects current use of medical terminology and devices
Lacks detail Added specificity
Lacks laterality Captures laterality
Generic  terminology for body parts Detailed descriptions for body parts
Lacks descriptions of methodology and approach for procedures Provides detailed descriptions of methodology and approach for procedures
Lacks precision in defining procedures Gives precise definition of procedures with detail inclusive of body part, approach, any device used, and additional qualifying information

All codes in ICD-10-PCS are seven characters in length and each of the seven characters represents an aspect of the procedure. Following is a diagram that illustrates the seven characters of a code from the main section of ICD-10-PCS, the Medical and Surgical section:

Character 1 2 3 4 5 6 7
Definition Name of Section Body System Root Operation Body Part Approach Device Qualifier

The following exemplifies the meaning of each character of the code 0LB50ZZ, “Excision of right lower arm and wrist tendon, open”:

Medical and Surgical Tendons Excision Lower arm and wrist, right Open No Device No Device
0 L B 5 0 Z Z

For more ICD-10 articles, please visit our ICD-10 Updates page.

— Compiled by former CIPROMS ICD-10 Coordinator, Angela Hickman, CPC, CEDC, AHIMA-Approved ICD-10 CM/PCS Trainer, AHIMA Ambassador. All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com.

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