ICD-10-PCS

Key facts

Maintained by

Centers for Medicare and Medicaid Services (CMS)

Used for

Procedures on hospital inpatient claims only

Format

Exactly 7 alphanumeric characters; letters I and O are not used

Effective since

October 1, 2015, replacing ICD-9-CM procedure codes

Update cycle

Annual release effective October 1, with possible April 1 updates

What is ICD-10-PCS?

ICD-10-PCS is a procedure classification built for the United States. Unlike ICD-10-CM, it is not an adaptation of a World Health Organization classification. It was developed under contract for the Centers for Medicare and Medicaid Services (CMS), which maintains it.

HIPAA names ICD-10-PCS as the standard for procedures reported on hospital inpatient claims. Physician services during the same stay, and all outpatient procedures, are coded with CPT or HCPCS instead. A single surgery can therefore appear with an ICD-10-PCS code on the hospital claim and a CPT code on the surgeon claim.

How an ICD-10-PCS code is built

Every code has exactly seven characters, and each position has a defined meaning within its section. In the Medical and Surgical section, which holds most codes, the positions are:

Other sections cover areas such as obstetrics, imaging and administration of substances. A New Technology section (X) captures specific new devices, drugs and procedures, often those tied to Medicare new technology add-on payments.

• Section, such as 0 for Medical and Surgical.
• Body system.
• Root operation, such as excision, replacement or bypass.
• Body part.
• Approach, such as open or percutaneous endoscopic.
• Device left in place at the end of the procedure.
• Qualifier for an additional attribute.

Why ICD-10-PCS matters

Because codes are highly granular, analyses usually group many codes into a clinical procedure category before counting.

• Procedure codes feed Medicare Severity Diagnosis Related Group (MS-DRG) assignment, so they directly affect inpatient hospital payment.
• Inpatient claims and hospital discharge datasets show which facilities perform procedures such as transplants, joint replacements or implant surgeries, and in what volume.
• The approach and device characters let device companies separate, for example, open from percutaneous procedures in inpatient data.
• New Technology section codes make it possible to track uptake of specific products that received add-on payments.