Development of the ICD-10 Procedure Coding System (ICD-10-PCS) Richard F. Averill, M.S., Robert L. Mullin, M.D., Barbara A. Steinbeck, RHIT, Norbert I. Goldfield, M.D, Thelma M. Grant, RHIA The International Classification of Dis- Introduction eases 10th Revision Procedure Classifica- tion System (ICD-10-PCS) has been Volume 3 of the International Classifica- developed as a replacement for Volume 3 tion of Diseases 9th Revision Clinical of the International Classification of Dis- Modification (ICD-9-CM) has been used in eases 9th Revision. The development of the U.S. for the reporting of inpatient pro- ICD-10-PCS was funded by the U.S. cedures since 1979. The structure of Vol- Health Care Financing Administration. ume 3 of ICD-9-CM has not allowed new ICD-10-PCS has a multi-axial seven char- procedures associated with rapidly chang- acter alphanumerical code structure which ing technology to be effectively incorpo- provides a unique code for all substantially rated as new codes. As a result, in 1992 different procedures and which allows new the U.S. Health Care Financing Adminis- procedures to be easily incorporated as tration (HCFA) funded a project to produce new codes. ICD-10-PCS was under devel- a preliminary design for a replacement for opment for over five years and the initial Volume 3 of ICD-9-CM. After a review of the preliminary design, HCFA in 1995 draft was formally tested and evaluated by awarded 3M Health Information Systems a an independent contractor. The final ver- three year contract to complete the devel- sion of the ICD-10-PCS was released in opment of a replacement system. The new the Spring of 1998. The design, develop- system is named ICD-10 Procedure Cod- ment and testing of ICD-10-PCS are dis- ing System (ICD-10-PCS). cussed. The development of ICD-10-PCS has _________________________________ four major objectives: The ICD-10-PCS is being developed with the support of the Health Care Financing Administration, under contract Nos. 90-1138, 91-22300 and Completeness 500-95-0005 to 3M Health Information Systems. Consultation in the development of ICD-10-PCS was provided by Donn G. Duncan, M.D. There should be a unique code for all and Gerard M. Doherty, M.D. The coding staff of the Division of Prospec- tive Payment System, Office of Hospital Policy, Bureau of Policy Devel- substantially different procedures. In opment of the Health Care Financing Administration, DHHS, provided Volume 3 of ICD-9-CM, procedures on ongoing review and evaluation during the development of the ICD-10- PCS: Patricia E. Brooks, Ann Bowling Fagan, Amy L. Gruber. A wide different body parts, with different range of physician specialty societies, individual clinicians, health care approaches, or of different types are professionals and researchers provided valuable input into the research. The Tabular List, Code Descriptions, and Index were computer gener- sometimes assigned to the same code. ated based on an expert system designed by: Yvette Wang, Laurence Gregg, Enes Elia, and David Gannon. Address correspondence and Expandability requests for reprints to Richard F. Averill, M.S., Senior Director, Clinical Research Department, 3M Health Information Systems, 100 Barnes Road, Wallingford, CT 06492. Robert L. Mullin, M.D., Barbara Steinbeck, As new procedures are developed the ART, Norbert I. Goldfield, M.D., Thelma Grant, RRA, are with 3M Health Information Systems, 3M Health Care. The opinions expressed are solely structure of ICD-10-PCS should allow those of the authors and do not necessarily reflect the views or policy them to be easily incorporated as unique positions of 3M Health Information Systems or the Health Care Financing Administration. codes. 3M HIS Research Report 4-98 1 Multi-axial information available in the medical record ICD-10-PCS should have a multi-axial to support the specificity required by ICD- structure with each code character having 10-PCS. the same meaning within a specific Limited Use of Not Elsewhere Classified procedure section and across procedure (NEC) Option sections to the extent possible. ICD-9-CM will often provide a “not Standardized Terminology elsewhere classified” option. All possible ICD-10-PCS should include definitions components of a procedure are specified of the terminology used. While the in ICD-10-PCS, thus, in general, there is meaning of specific words can vary in no need for a “not elsewhere classified” common usage, ICD-10-PCS should not option. However, new devices are include multiple meanings for the same frequently being developed and therefore, term and each term must be assigned a for devices, it is necessary to have a “not specific meaning. elsewhere classified” option that can be used until the new device can be explicitly If these four objectives are accom- added to the coding system. Likewise, an plished, then ICD-10-PCS should enhance NEC option is included in the nuclear the ability of health information coders to medicine section that can be used for determine accurate codes with minimal newly approved radiopharmaceuticals effort. until they can be explicitly added to the In the development of ICD-10-PCS, coding system. there were several general guidelines that Level of Specificity were followed: Based on the combinations of the seven Diagnostic Information is Not Included in alphanumeric characters, all possible Procedure Description procedures were defined. Frequency of When procedures are performed for occurrence was not a consideration in the specific diseases or disorders, the disease development of the system. A code was or disorder is not specified. Thus, there created for any procedure that could be are no separate codes for procedures for performed. aneurysms, cleft lip, strictures, neoplasms, ICD-10-PCS has a seven character hernias, etc. The diagnosis codes and not alphanumeric code structure. Each char- the procedure codes contain the specific acter has up to 34 different values. The information regarding the nature of the ten digits 0-9 and the 24 letters A-H,J-N disease or disorder. and P-Z comprise each character. The let- Explicit Not Otherwise Specified (NOS) ters O and I are not used in order to avoid Options are Not Provided confusion with the digits 0 and 1. ICD-9-CM will often provide a “not Procedures are divided into sections otherwise specified” option. Explicit NOS that relate to the general type of procedure options are not provided in ICD-10-PCS. A (e.g., medical and surgical, imaging, etc.). minimal level of specificity is always The first character of the procedure code required for each component of the always specifies the section. The sections procedure. For each component of the are shown in Table 1. procedure there are ICD-10-PCS coding rules that specify how the procedure The second through seventh characters should be coded when there is insufficient have a standard meaning within each sec- 2 3M HIS Research Report 4-98 Sections direct look up of each code and provides a 0 Medical and Surgical short description of each code. 1 Obstetrics Tabular List in ICD-10-PCS Manual 2 Placement 3 Administration The Tabular List in ICD-10-PCS has a 4 Measurement and Monitoring very different organization than ICD-9-CM. 5 Imaging Each page in the Tabular List is composed 6 Nuclear Medicine of grids which specify the valid combina- 7 Radiation Oncology tions of character values that comprise a 8 Osteopathic particular procedure code. Table 2 shows 9 Rehabilitation and Diagnostic Audiology a portion of a page from the Tabular List. B Extracorporeal Assistance and Performance The upper portion of each grid contains a C Extracorporeal Therapies description of the first two or three charac- D Laboratory ters of the procedure code. For example, F Mental Health for procedures in the medical and surgical G Chiropractic section the first three characters are the H Miscellaneous name of the section, the body system and the root operation being performed. Table 1: Sections In ICD-10-PCS characters 027 would tion but may have different meanings indicate that the grid refers to the medical across sections. and surgical section (0) of the body sys- In most sections, one of the characters tem heart & great vessels (2) and a root specifies the precise type of procedure operation of dilation (7). As shown in Table being performed (e.g., excision, resection, 2 the root operation (i.e., dilation) is fol- etc.), while the other characters specify lowed by its definition. additional information such as the body The lower portion of the grid specifies all part on which the procedure is being per- the valid combinations of characters four formed. In the ICD-10-PCS the term “pro- through seven. The four columns in the cedure” is used to refer to the complete grid represent the last four characters and specification of the seven characters. for the medical and surgical section are labeled Body Part, Approach, Device and ICD-10-PCS Manual Qualifier, respectively. Each row in the grid defines the valid combinations of charac- In the ICD-10-PCS system, the ICD-10- ters four through seven. The Tabular List PCS codes are described in three sepa- contains only combinations of characters rate divisions. that represent a valid procedure. Combi- Tabular Listing nations of characters that do not constitute Index a valid procedure are not contained in the List of Codes Tabular List. The Index allows codes to be located by The grid in Table 3 generates 48 unique an alphabetic look up. The Index entry will procedure codes. For example, code refer to a specific location in the Tabular 02705DZ represents the procedure for List. Reference to the Tabular List is dilation of one coronary artery using an always necessary in order to obtain the intraluminal device by a percutaneous complete code.