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 code consists of between three to seven digit alphanumeric codes all specifying the procedure. The first digit of the code is used to indicate the area of medical practice such as monitoring, measuring, surgery and administration among other. The rest of digits indicate the body system, the root operation, the body part, the approach used and the devise used in the procedure. The seventh character is the quantifying digit.

The ICD-10 replaced the ICD-9 version and is set to take effect in October 1, 2014 bringing about drastic changes in the entire health sector in United States affecting all players from federal government, state governments, insurance firms, medical facilities to health professionals. The ICD-10 has two major components, the ICD-10-CM (CM being abbreviation for clinical modification) and ICD-10-PCS (PCS for Procedure Coding System).

With the implementation of ICD-10 coding system, the hospitals are expected to have 87, 000 new codes for all in-patient procedure coding replacing the existing 8,660 CPT codes. The replacement however takes place for the in-patient procedures only. The new codes are not applicable for billing the radiologist components and out-patient services, procedures and studies. The implication is that identical procures are described by CPT codes for out-patients but with ICD-10 for in-patients.

Even with the transition, a number of players are not converting to ICD-10 codes. In this group are the auto insurance companies, the legal claims and workers comp which prompts hospitals to use a mixture of ICD-9, ICD-10, ICD-10-PCS and CPT codes for the management and billing system. The hospital management system must therefore have ability and knowledge required for automatic conversion of ICD-9 codes to 10 and back, Convert CPT code to ICD-10 or nine and back. This should be done with ease, efficiency and comfort for smooth operations and transition.

Given that some players like the auto insurance, legal claims and workers comps are not expected to convert to the new coding system, the hospitals are likely to use CPT, ICD-9, ICD-10-CM and ICD-10-PCS all at the same time. This calls for capacity evaluation, ability training and general knowledge in the part of healthcare providers to keep up to the demand of converting from one coding system to the other and back in an efficient and easy manner.

If you choose the option of upgrading the system as required, there are a few challenges that you need to prepare for as suggested by studies done on countries that have already converted to the new coding system. These include increased time per claim for coders, need to additional staff, concurrent processing of ICD-9, 10 and the new in-patient code, disruption of reimbursements and possible backlog of programming requests.

The last minute rush, expect confusion and delays as hospitals, clinics, surgery centers, insurance companies, the CMS, the State Medicaid and all other healthcare providers try to comply in October 1, 2014 should be avoided. There are concerns arising from the implementation of ICD-10-PCS such as the possibility of using detailed information from this code to exclude coverage by the government and private insurance.

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