ICD-10 PCS – We Don't Know What We Don't Know

By Dr. Jon Elion, founder and CEO, ChartWise Medical Systems

After decades of experience with ICD-9, we have learned and come to grips with its quirks. We do not yet have that comfort level with ICD-10 – after all, it’s still pretty new to most of us in the U.S. I’m not really concerned about the diagnosis side of ICD-10 and its Clinical Modification, ICD-10-CM. But what does concern me is ICD-10 PCS. So far, we don’t have a good idea of how this is going to impact reimbursement, and what documentation requirements are really going to be needed. We really don’t know what we don’t know.

ICD-10-PCS coding demands a new level of documentation and coding specificity. There are few procedure codes in ICD-10 that will allow nonspecific or “not otherwise specified” codes, as are allowed in ICD-9. In the ICD-9 coding environment, it is still possible to generate a code and get reimbursed even with minimal specificity. But under ICD-10, if specificity is lacking, there may not be a procedure code that can be used, and the reimbursement will therefore suffer.

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