It is a reality in today's modern medical science that the codes within ICD-9-CM fall woefully short of today's medical reporting needs. ICD-9-CM was created more than 25 years ago as a modern and expansive system that was then only partially filled. Thousands of codes have been added to ICD-9-CM to classify new procedures and diseases over the years, and today the remaining space in ICD-9-CM procedure and diagnosis coding systems cannot accommodate our new technologies or our new understanding of diseases. An overhaul of our coding systems is needed.

Through the World Health Organization (WHO), ICD-10 was created and adopted in 1994. This is the system upon which the new U.S. diagnosis coding system, ICD-10-CM, is based. Concurrent to the clinical modification of ICD-10 by the National Center for Health Statistics (NCHS), the Centers for Medicare and Medicaid Services (CMS) commissioned 3M Health Information Management to develop a new procedure coding system to replace volume 3 of ICD-9-CM, used for inpatient procedure coding.

WHO's original intent for ICD was as a statistical tool for the international exchange of mortality data. A subsequent revision was expanded to accommodate data collection for morbidity statistics. An eventual seventh revision, published by WHO in 1955, was clinically modified for use in the United States. WHO's seventh edition of ICD was the first edition modified by the United States for its own clinical use. Two versions of a modified ICD-8 were published later in 1968. A procedure classification was created by the U.S. Government that accompanied the clinical modification of ICD-9, and was published here in 1978 as a three-volume set.

The evolution of ICD took another turn in 1994 when WHO published ICD-10. The NCHS wanted to modify the latest revision with an emphasis on problems identified in the current ICD-9-CM to be resolved by the clinical modification improvements to ICD-10. The analysis for clinical modification identified that ICD-10 must be modified to do the following:

Return the level of specificity found in ICD-9-CM
Facilitate an alphabetic index to assign codes
Provide code titles and language that
complement accepted clinical practice
Remove codes unique to mortality coding

Clinical modifications were then developed based on the analysis, including the following:

Increasing the five-character structure to six and seven characters
Incorporating common fourth- and fifth-digit subclassifications
Creating laterality
Combining certain codes
Adding trimesters to obstetric codes
Creating combined diagnosis/symptoms codes
Expanding alcohol/drug abuse codes, diabetes mellitus codes, and injury codes

A draft was then presented for public comment at the conclusion of this phase of development. The final version will draw on an analysis of the comments by NCHS and reviewers.

ICD-10-PCS

ICD-10-PCS was developed to replace ICD-9-CM volume 3 under a three-year contract with CMS, beginning in 1995. PCS was developed with these CMS objectives in mind: completeness, expandability, uniform structure, and standardized terminology. The contract included completion of the first draft in year one; training and testing in inpatient and outpatient facilities with revision of the system to accommodate problems revealed in testing; and formal testing in the third year. The testing has been completed and results have been reviewed by specialty groups independent of CMS and tested at Clinical Data Abstractions Centers (CDAC). Their work resulted in a final version now standing ready as a replacement for ICD-9-CM volume 3.

The American Health Information Management Association, in testimony at the May 2001 Coordination and Maintenance Committee hearing on ICD-10-PCS, suggested that before ICD-10-PCS is implemented, the issue of one or two procedure coding systems should be decided as the issue of replacing ICD-9-CM volume 3 with ICD-10-PCS has become somewhat politicized.

ICD-10 Corner - History of ICD 10-CM/PCS

History of ICD-10-CM

ICD-9-CM was adopted almost 30 years ago as a modern and expansive system that was then only partially filled. Over the years thousands of codes have been added to ICD-9-CM to classify new procedures and increase medical knowledge of diseases. Coded data has a far more reaching influence than ever before. Several healthcare initiative such as value-based purchasing and quality performance initiative, practice standards, quality measures, outcomes measure, utilization review, disease management, research and biosurveillance place great demand and importance on coded data. An efficient means of evaluating services provided to beneficiaries, thereby accomplishing value-base purchasing greater requires a greater specificity in diagnosis and procedure codes. Today the remaining space in ICD-9-CM procedure and diagnosis coding systems cannot accommodate our new technologies or our new understanding of diseases. The coding system was designed with today’s knowledge of disease or demand for specificity in coded data. An overhaul of our coding systems is needed that would allow for specificity and be expanded as knowledge and technology advances.

Through the World Health Organization (WHO), ICD-10 was created and adopted in 1994. This is the system upon which the new U.S. clinical modification of diagnosis coding system, ICD-10-CM, is based. Concurrent to the clinical modification of ICD-10 by the National Center for Health Statistics (NCHS), the Centers for Medicare and Medicaid Services (CMS) commissioned 3M Health Information Management to develop a new procedure coding system to replace volume 3 of ICD-9-CM, used for inpatient procedure coding.

WHO's original intent for ICD was as a statistical tool for the international exchange of mortality data. A subsequent revision was expanded to accommodate data collection for morbidity statistics. An eventual seventh revision, published by WHO in 1955, was clinically modified for use in the United States. WHO's seventh edition of ICD was the first edition modified by the United States for its own clinical use. Two versions of a modified ICD-8 were published later in 1968. A procedure classification was created by the U.S. Government that accompanied the clinical modification of ICD-9, and was published here in 1978 as a three-volume set.

The evolution of ICD continued in 1994 when WHO published ICD-10. The NCHS began to modify this latest WHO revision with an emphasis on problems identified in the current ICD-9-CM. The analysis for clinical modification identified that ICD-10 must be modified to resolve the following:
- Return and improve the level of specificity found in ICD-9-CM
- Facilitate an alphabetic indexing to assign codes
- Provide code titles and language that align with accepted clinical practice
- Remove codes unique to mortality coding

Clinical modifications were then developed based on the analysis, including the following:

-Increasing the five-character structure to six and seven characters
-Incorporating common fourth- and fifth-digit sub classifications
-Creating laterality
-Combining certain codes
-Adding trimesters to obstetric codes
-Creating combined diagnosis/symptoms codes
-Expanding alcohol/drug abuse codes, diabetes mellitus codes, and injury codes

Several drafts have been presented for public comment and testing since the conclusion of the first phase of development. The final version will draw on an analysis of the comments by NCHS and reviewers.

History of ICD-10-PCS

ICD-10-PCS was developed and has been updated by 3M Health Systems under a contract with CMS to replace ICD-9-CM volume 3 for the reporting of procedures or other actions taken for diseases, injuries, and impairments on inpatients reported by hospitals: prevention, diagnosis, treatment, and management.

In 1995 development of ICD-10- PCS was started with these CMS objectives in mind:
-Completeness
-Expandability
-Multi-axial code structure
-Standardized terminology
-Exclusion of diagnostic information
-Minimal level of specificity required ( NOS options not available)
-Limited use of NEC option
-Level of specificity to cover all variations of a procedure

The result of this initiative was an seven-character alphanumeric classification system covering medical, surgical, and ancillary procedures or other actions taken for diseases, injuries, and impairments on inpatients reported by hospitals for prevention, diagnosis, treatment, and management.

The contract included completion of the first draft in year one; training and testing in inpatient and outpatient facilities with revision of the system to accommodate problems revealed in testing; and formal testing in the third year. The testing and results have been reviewed by specialty groups independent of CMS and tested at Clinical Data Abstractions Centers (CDAC). Their work resulted in a final version now standing ready as a replacement for ICD-9-CM volume 3.

Please review the information under ‘Regulatory Process’ and the ‘NPRM Summary’ for more information regarding the need for adoption of the new coding system and the current status of adoption of ICD-10-CM and ICD-10-PCS in the United States.