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Introduction to the ICD-10 Coding System

Introduction to the ICD-10 Coding System


This article will summarize the following:

  • Understand the purpose of the ICD-10 coding system.

  • Explain the history of medical coding.

  • Describe the process of ICD maintenance and revision. 

The ICD-10 is the chronological successor to the ICD-9 system. This new classification system provides many improvements through detailed information and the ability to expand in order to obtain additional advancements in medicine. The ICD-10 classification system consists of two different code sets: ICD-10-CM and the ICD-10-PCS. ICD-10-CM stands for the International Classification of Diseases (ICD), Tenth Revision (10), Clinical Modifications (CM). ICD-10-PCS stands for the International Classification of Diseases (ICD), Tenth Revision (10), Procedure Coding System (PCS) (Davis, 2011). 

The ICD-10-CM is the diagnosis classification system developed by the Centers for Disease Control and Prevention (CDC) to allow healthcare facilities and providers assign a "diagnosis code" for billing purposes. The format is similar to the ICD-9-CM, but with ICD-10-CM system, 3 to 7 alpha and numeric digits and full code titles are used. The ICD-10-PCS is the procedure classification system developed by the Centers for Medicare & Medicaid Services (CMS) to allow healthcare facilities and providers in the U.S. bill for inpatient hospital setting services. The ICD-10-PCS system uses 7 alpha or numeric digits, where the previously used system, the ICD-9-CM, only used 3 or 4 numeric digits (Davis, 2011). 

History of Coding

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The first coding system was introduced in 1893 by Jacques Bertillon, a French physician. Bertillon presented Bertillon Classification of Causes of Death to the International Statistical Institute in Chicago, and from there, many countries and cities adopted this system. The Bertillon system distinguished between general diseases and those illnesses localized to a particular anatomical site or organ. Many revisions of this classification system developed from the original 44 Bertillon titles. In 1898, the American Public Health Association (APHA) recommended that the United States, Canada, and Mexico use this system and suggested updating it every ten years. After many revisions, the title was changed to International Statistical Classification of Diseases, Injuries, and Causes of Death. In 1948, the World Health Organization (WHO) assumed the responsibility for preparing and publishing the classification system (Davis, 2011). 

Building on the classification system used by the WHO, the U.S. Public Health Service published the International Classification of Diseases, Adapted for Indexing of Hospital Records and Operation Classification (ICDA) in 1962.  In 1979, the reporting of procedures for hospital inpatients has been done using the International Classification of Diseases Ninth Revision, Clinical Modification (ICD-9-CM). After many revisions and editions, the U.S. Department of Health and Human Services published the International Classification of Diseases, Ninth Revision, Clinical Modification system, called the ICD 9-CM, which remains the data standard for reporting morbidity (Barta, DeVault, & Zeisset, 2011). 

After many national adaptions, the ICD-10-CM and ICD-10-PCS were completed in 2003.Because the ICD-9-CM was outdated and could not be expanded to identify certain levels of detail for various procedure codes, the CMS developed the International Classification of Diseases, Tenth Revision, Procedure Classification System (ICD-10-PCS). To be initiated October 1, 2014, the ICD-10-PCS has four key attributes: completeness, expandability, multiaxial, and standardized terminology (Barta, DeVault, & Zeisset, 2011). 




It offers a unique code for each procedure.


The structure allows for easy expansion.


It contains independent characters and axis to maintain meaning across various ranges of codes.

Standardized Terminology

It uses definitions that are well-defined and terms with no multiple meanings.

Maintenance and Revision

The Department of Health and Human Services (HHS) works with the American Hospital Association (AHA) regarding the ICD-9-CM, ICD-10-CM, and ICD-10-PCS. These organizations maintain official coding guidelines and offer advice on use of this system. The clinical modification of the ICD-10 uses a different approach to coding that in the previous versions of the ICD (Grebner & Suarez, 2013). 

The implementation of the ICD-10 system is not the end of the story. Rather, it is a bridge between revisions. The WHO is already developing the ICD-11, with the final draft due for submission by 2014. There will be three distinct versions of the ICD-11, which are defined by level of care: primary care, clinical, and research. The content model uses 13 main parameters: ICD entity title, classification properties, textual definitions, terms, body system/structure descriptions, temporal properties, severity of subtypes properties, manifestation properties, casual properties, functioning properties, specific condition properties, treatment properties, and diagnostic criteria (Grebner & Suarez, 2013).

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