What is the difference between ICD 10 CM and ICD 10 PCS?

Asked By: Maika Camazon | Last Updated: 1st July, 2020
Category: healthy living childrens health
4.6/5 (569 Views . 28 Votes)
The main differences between ICD-10 PCS and ICD-10-CM include the following: ICD-10-PCS is used only for inpatient, hospital settings in the U.S., while ICD-10-CM is used in clinical and outpatient settings in the U.S. ICD-10-PCS has about 87,000 available codes while ICD-10-CM has about 68,000.

Click to see full answer


Beside this, what is the difference between ICD 10 CM and ICD 10?

When most people talk about ICD-10, they are referring to ICD-10CM. This is the code set for diagnosis coding and is used for all healthcare settings in the United States. ICD-10PCS, on the other hand, is used in hospital inpatient settings for inpatient procedure coding.

Furthermore, what is the difference between CPT and ICD 10 PCS? ICD-10-PCS. I often get asked, “Why do we need two coding systems for procedures?” The simple answer is that CPT is a nomenclature (a naming system) and ICD-10-PCS is a classification system. ICD-10-PCS classifies procedures in a systematic grouping system.

Secondly, are ICD 10 CM and ICD 10 PCS interchangeable?

ICD-10-PCS. With the transition to ICD-10, in the United States, ICD-9 codes are segmented into ICD-10-CM and ICD-10-PCS codes. ICD-10-PCS is a completely separate medical coding system from ICD-10-CM, containing an additional 87,000 codes for use ONLY in United States inpatient, hospital settings.

How many ICD 10 codes can be billed?

While you can include up to 12 diagnosis codes on a single claim form, only four of those diagnosis codes can map to a specific CPT code. That's because the current 1500 form allows space for up to four diagnosis pointers per line, and that won't change with the transition to ICD-10.

29 Related Question Answers Found

What are the three main steps to coding accurately?

Here are three steps to ensure you select the proper ICD-10 codes:
  • Step 1: Find the condition in the alphabetic index. Begin the process by looking for the main term in the alphabetic index.
  • Step 2: Verify the code and identify the highest specificity.
  • Step 3: Review the chapter-specific coding guidelines.

Why is ICD 10 important?

The ICD-10 code system offers accurate and up-to-date procedure codes to improve health care cost and ensure fair reimbursement policies. The current codes specifically help healthcare providers to identify patients in need of immediate disease management and to tailor effective disease management programs.

How many ICD 10 codes are there?

There are over 70,000 ICD-10-PCS procedure codes and over 69,000 ICD-10-CM diagnosis codes, compared to about 3,800 procedure codes and roughly 14,000 diagnosis codes found in the previous ICD-9-CM.

What are ICD 10 codes used for?

ICD-10 codes are alphanumeric codes used by doctors, health insurance companies, and public health agencies across the world to represent diagnoses. Every disease, disorder, injury, infection, and symptom has its own ICD-10 code.

What are the benefits of ICD 10 CM?


9 benefits of ICD-10
  • Measuring the quality, safety and efficacy of care.
  • Designing payment systems and processing claims for reimbursement.
  • Conducting research, epidemiological studies, and clinical trials.
  • Setting health policy.
  • Operational and strategic planning and designing healthcare delivery systems.

How do you find ICD 10 codes?

ICD-10: How to Find the Correct Code in 5 Steps
  1. Order the lists today. Both can be downloaded from the CMS website (www.cms.gov/icd10).
  2. Tip.
  3. Step 2: Check the Tabular List.
  4. Step 3: Read the code's instructions.
  5. Example.
  6. Example.
  7. Step 5: If glaucoma, you may need to add a seventh character.
  8. Example.

Do all ICD 10 codes start with a letter?

Layout and Organization
ICD-10-CM is a seven-character, alphanumeric code. Each code begins with a letter, and that letter is followed by two numbers. The first three characters of ICD-10-CM are the “category.” The category describes the general type of the injury or disease.

Why are both ICD 10 and CPT codes required to be submitted?

Why do coders have to submit both ICD-10 and CPT codes? The ICD-10 code is the reason for the procedure and the CPT code is the procedure. You can not bill and be reimbursed for the CPT without the ICD-10 and vise versa. Insurance carriers will laugh at you if you try.

Which letters are not used in ICD 10 PCS?

What Are Some Differences Between ICD-9-PCS and ICD-10-CM-PCS
ICD-9-PCS ICD-10-PCS
3-4 digits 7 digits
all digits are numeric digits can be either alpha or numeric. Letters O and I are not used to avoid confusion with the numbers 0 and 1.

What does ICD 10 PCS stand for?


The International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) is a U.S. cataloging system for procedural codes that track various health interventions taken by medical professionals.

What was one reason that ICD 10 PCS was created?

The International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) was developed as a replacement for the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) volume 3, Procedures.

What is the purpose and function of the ICD 10 PCS coding system?

This procedure coding system is used to gather data, collect information, determine payment, and support the electronic health record for all inpatient services and procedures performed in the U.S. Codes can be built from the index, tables, and appendices provided in the ICD-10-PCS manual.

What is the difference between diagnosis and procedure codes?

The CPT code describes what was done to the patient during the consultation, including diagnostic, laboratory, radiology, and surgical procedures while the ICD code identifies a diagnosis and describes a disease or medical condition.

What is the latest version of ICD 10?


ICD-10, as it is therefore known, is from 1992 and the WHO publishes annual minor updates and triennial major updates. The eleventh revision of the ICD (ICD-11) was accepted by WHO's World Health Assembly (WHA) on 25 May 2019 and will come into effect on 1 January 2022.

What is the purpose of the ICD 10 PCS?

ICD-10-PCS will be the official system of assigning codes to procedures associated with hospital utilization in the United States. ICD-10-PCS codes will support data collection, payment and electronic health records. ICD-10-PCS is a medical classification coding system for procedural codes.