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ICD-10 Overview

The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). The code set allows more than 14,400 different codes and permits the tracking of many new diagnoses.

ICD-10 is an updated version of the ICD-9 code sets. Several countries have taken the ICD-10 code set and modified it for use in their medical systems. The United States, through the National Center for Health Statistics, has developed the ICD-10-CM (or Clinical Modification) version of the code set for use in the US. The Centers for Medicare & Medicaid Services (CMS) has created a new code set, ICD-10-PCS (or Procedure Coding System), for use. These code sets are considered classification code sets. They are at a higher level of information than some other medical code sets like the Systematized Nomenclature of Medicine (SNOMED), which is used by federal government systems for the electronic exchange of clinical health information. View additional information on ICD-10 Final Regulation and Training.

Current Use of ICD-9-CM Code Set and Other Code Sets

Current health plan systems and health care providers are required by the Health Insurance Portability and Accountability Act (HIPAA) to use a standard code set to indicate diagnoses and procedures on transactions. For diagnoses, the ICD-9-CM code set is used. The ICD-9-CM procedure code set is used for inpatient hospital procedures. For other types of procedures, health plans and providers use Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, which explain the soon-to-be required ICD-10-CM codes for diagnoses and ICD-10-PCS codes for inpatient hospital procedures. There are no plans to radically change the CPT or HCPCS code sets.

Major Changes from ICD-9 to ICD-10

Unlike the usual annual updates of ICD-9 codes, the ICD-10 codes are markedly different from their predecessors. Get more information about ICD-10 changes from ICD-9. And because ICD-9 codes are used in almost every clinical and administrative process in a health care setting, substantial system and procedural changes will be necessary to implement and correctly use the new codes. The updated code sets will allow, and in fact will require, significant changes in the way health plans reimburse services, and in the way coverage of services is determined. ICD-10 will enable significant improvements in care management, public health reporting, research, and quality measurement.

For more information about ICD-10, please visit http://www.cms.gov/ICD10/.