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 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.

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 the targeted year of full transition (2014) is here with us, you ought to have taken all the necessary steps towards this transition. There are only three alternatives if you are a healthcare player; to upgrade or replace the entire billing management system, outsource your services or opt for retirement.

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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