The ICD-10 Clinical Modification (ICD-10-CM) is a set of

diagnosis code In health care, diagnosis codes are used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnostic coding is the translation of ...

s used in the

United States of America The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 states and a federal capital district, Washington, D.C. The 48 contiguo ...

. It was developed by a component of the U.S. Department of Health and Human services, as an adaption of the

ICD-10 ICD-10 is the 10th revision of the International Classification of Diseases (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social cir ...

with authorization from the

World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...

. In 2015, ICD-10-CM replaced

ICD-9-CM The International Classification of Diseases (ICD) is a globally used medical classification that is used in epidemiology, health management and clinical diagnosis. The ICD is maintained by the World Health Organization (WHO), which is the direc ...

as the federally mandated classification. Annual updates are provided.

Development

Since 1979, the US had required ICD-9-CM codes for Medicare and

Medicaid Medicaid is a government program in the United States that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by U.S. state, state governments, which also h ...

claims, and most of the rest of the medical industry in the US followed suit. On January 1, 1999, the ICD-10 (without clinical extensions) was adopted for reporting mortality, however, ICD-9-CM continued to be used for

morbidity A disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical conditions that are asso ...

. During that time, the U.S.

National Center for Health Statistics The National Center for Health Statistics (NCHS) is a U.S. government agency that provides statistical information to guide actions and policies to improve the public health of the American people. It is a unit of the Centers for Disease Control ...

(NCHS) received permission from the WHO to create a clinical modification of the ICD-10. ICD-10-CM adapted ICD-10 in the following ways: * Allow the capture of information for ambulatory and managed care encounters * Expand available injury codes * Combine codes for diagnosis/symptoms to reduce the number of codes needed to describe a problem fully * Provide additional sixth and seventh digit classifications * Add classifications specific to laterality * Refine classification for increased data granularity

Adoption

Adoption of ICD-10-CM was slow. On August 21, 2008, the

US Department of Health and Human Services The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the US federal government created to protect the health of the US people and providing essential human services. Its motto is ...

(HHS) proposed new code sets to be used for reporting diagnoses and procedures on health care transactions. Under the proposal, the ICD-9-CM code sets would be replaced with the ICD-10-CM code sets, effective October 1, 2013. On April 17, 2012, the Department of Health and Human Services (HHS) published a proposed rule that would delay the compliance date for the ICD-10-CM and PCS by 12 months-from October 1, 2013, to October 1, 2014. Congress further delayed the implementation date to October 1, 2015, after it was inserted into the "Doc Fix" Bill without debate over the objections of many.

Release

On October 1, 2015, ICD-10-CM replaced volumes 1 and 2 of ICD-9-CM, and

ICD-10-PCS The ICD-10 Procedure Coding System (ICD-10-PCS) is a US system of medical classification used for procedural coding. The Centers for Medicare and Medicaid Services, the agency responsible for maintaining the inpatient procedure code set in the U. ...

replaced volume 3.

Annual review

The ICD-10-CM code set is reviewed every year. The code set for the 2023

fiscal year A fiscal year (also known as a financial year, or sometimes budget year) is used in government accounting, which varies between countries, and for budget purposes. It is also used for financial reporting by businesses and other organizations. La ...

applies to patient discharges and encounters between October 1, 2022, and September 30, 2023 (inclusive) – with the exception of four codes that were in effect from April 1, 2022.

References

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External links