International Classification of Diseases (ICD) codes are used to codify medical diagnosis and procedures; calculate and adjudicate coverage; compile medical statistics; assess quality of care and help manage clinical quality outcomes for patients. ICD-9 code sets were outdated, didn’t reflect advances in medical technologies and weren’t descriptive enough.
ICD-10 Clinical Modifications (CM) and ICD-10 Procedure Coding Structure (PCS) are the latest medical code sets under HIPAA-AS and represent a fundamental overhaul to the former ICD-9 coding system. A federal mandate required all HIPAA-covered entities to adopt ICD-10 by Oct. 1, 2015.
The ICD-10 CM and PCS classification system has been implemented to provide:
Improved patient care quality because of greater detail and an increased ability to accommodate new technologies and procedures.
Richer medical data with higher degrees of detail and quality for further analysis; helps to enrich clinical care profiles and patient outcomes.
Enhanced claim processing by requiring more detailed information in the diagnosis and procedure code assignments.
Increased interoperability across industry stakeholders worldwide by phasing out aging and inflexible technical systems.