ICD-10-PCS
ICD-10-PCS is the procedure coding system used to report inpatient hospital procedures, distinct from the ICD-10-CM diagnosis codes used across all settings.
Updated
ICD-10-PCS — the International Classification of Diseases, 10th Revision, Procedure Coding System — is the code set used to report procedures performed in the inpatient hospital setting. Where ICD-10-CM codes report diagnoses, ICD-10-PCS codes report the inpatient procedures themselves, and the two are used together on an inpatient hospital claim to describe the patient's condition and what was done.
ICD-10-PCS is maintained by CMS and is structured quite differently from CPT: each code is built from seven characters (each drawn from a defined value set for its position) rather than selected from a published list, so coding is a construction process against the definitions. It applies to inpatient hospital procedures only, not to professional or outpatient services.
In practice
Because inpatient hospital payment under the MS-DRG system is driven by coded diagnoses and procedures, an ICD-10-PCS code that places a case into a different MS-DRG changes the bundled payment for the stay. Inpatient procedure coding accuracy is therefore a direct driver of hospital reimbursement and a common audit target.
Commonly confused with
- ICD-10-CM code: ICD-10-CM reports diagnoses (the why) across all settings; ICD-10-PCS reports inpatient hospital procedures (the what was done) and is used only for inpatient hospital coding.
- CPT code: CPT reports physician and outpatient procedures; ICD-10-PCS reports inpatient hospital procedures. A single inpatient encounter can generate CPT codes for the physician side and ICD-10-PCS codes for the facility side.