Information On ICD-10-PCS And Need For Early Compliance

By Violet Solomon


The International Classification of Disease 10th revision Procedure Coding System is normally abbreviated as ICD-10-PCS. This is a system of medical classification that helps to procedurally give coding to health interventions that the medical professionals may choose. The World Health Organization normally publishes PCS so as to track the international morbidity and the mortality statistics for comparison.

The first digit in the code is used to indicate the medical practice section which can be surgery, monitoring, measuring, administration or any other section. The next digits specify the body system, root operation, the body part, the approach used and devices used in that order. The last character (seventh) is used as a qualifying digit. The first three characters are usually so crucial and are stored in the ICD manual to help in reference.

The ICD-10 came as a replacement of the ICD-9 and is set to take effect on October 1, 2014 bringing with it a dramatic change in medical and healthcare sector in general. All the players from federal government, state governments, medical professionals and the insurance firms are set to be affected by this new coding system.

While the ICD-10-PCS are used for in-patient procedures and studies, the same cannot be used when it comes to billing of the radiologist professional components. They are also not applicable for procedures and studies concerning out-patients. The implication is that this coding system describes the procedures that are performed on in-patients but the identical procedures performed on out-patients are still described by the original CPT codes.

The 10th Procedure Coding System is to be used for the in-patient services only. They will not be applicable when it comes to billing the radiologist components. The other significant area where they are not applicable is on the out-patient services. The implication is that a similar procedure performed on in-patient and out-patient is differently coded. For out-patients, CPT is used but ICD-10 is used for in-patients procedures.

As a healthcare provider in US, it is important to be fully compliant with the new coding system long before the October 1, 2014; the date of transition comes. This helps avoid the challenges associated with late attempts to comply such confusion and delays that are likely to be witnessed as there will be a rush from hospitals, surgery centers, clinics, CMS, insurance firms and State Medicaid and other players.

As an industry player, you have only three options of which only one is viable. You can choose to upgrade or completely change the billing management system, outsource the services or choose to retire before the transition date comes.

There are several benefits that come with early compliance such as being able to avoid confusion and delays as all other players seek to comply at last minute. In fact, this is likely to cause system backlogs. The transition to the ICD-10-PCS may not be as smooth as expected especially if the rumors and concerns arising are not fully addressed. The major concern comes from rumors that unspecific codes will be eliminated making it impossible to make claims for the related complications.




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