ICD-10 CM/PCS Procedure Basics And KPI Assesment
ICD-10 CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/ Procedure Coding System) consists of two parts:
- ICD-10-CM (diagnosis coding) was developed by the Centers for Disease Control and Prevention for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.
- ICD-10-PCS (inpatient procedure coding) was developed by the Centers for Medicare & Medicaid Services (CMS) for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.
The transition to ICD-10-CM/PCS does not affect Current Procedural Terminology (CPT) codes, which will continue to be used for outpatient services.
After you’ve made the switch to ICD-10, you can look for opportunities to analyze your progress. By tracking and comparing key performance indicators, or KPIs, you can identify and address any issues with productivity, reimbursement, claims submission, and other processes.
Get Started—Establish a Baseline for Each KPI The first step in using KPIs is to establish a baseline, or a point of comparison, for each KPI you’d like to track.
For purposes of assessing your ICD-10 progress, you’ll want to compare KPIs from before the October 1, 2015, transition date with KPIs from after the transition date. The pre-transition KPIs will serve as baselines. Ideally, you either:
- Already have pre-ICD-10 baseline data for some KPIs from your clearinghouse
- Can generate baseline data practice management system, electronic health record, or other health IT system If you’re a provider in a small practice, you might not have routinely used or tracked KPIs in the past, so you may need to start by developing a baseline.
Work with your billing and coding staff to see what data are already available in your systems, reports, and records. Check for data available from outside sources like:
- Clearinghouses
- Third-party billers
- System vendors
If you do not already have reports with KPI data for the year before the October 2015 transition, work with your clearinghouse or vendor to pull the data to create a baseline. On October 1, 2015, ICD-10 became effective for all HIPAA-covered entities.
It’s best to compare metrics with past calendar years by month. There’s some seasonality to statistics, and you will want to take into account local issues (e.g., impact of staff vacations). Keep this in mind when developing baselines.