INTRODUCTION OF ICD-10-CM

ICD-10 Was endorsed by the 43rd world health Assembly in May 1990 and came into use in world health organization (WHO) Member states in 1994.The classification is the latest in a series originating in the 1850s. The 1st edition, as the International List of cause of Death, was adopted by the International Statistical Institute in 1893. WHO took over responsibility for ICD at its creation in 1948 when the Sixth Revision , which included causes of morbidity for the 1st time, was published. The World Health Assembly adopted in 1967 the WHO Nomenclature Regulations stipulating use of ICD in its most current revision for mortality and morbidity statistics by all member states.


The ICD is the international standard diagnostic classification for all general epidemiological, many health management purposes, and clinical use. These include the analysis of the general health situation of population groups and monitoring of the incidence and prevalence of diseases and other health problems in relation to other variables such as the characteristics and circumstances of the individuals affected, reimbursement,resource allocation, quality and guidelines.

It is used to classify diseases and other health problems recorded on many types of health and vital records including death certificates and enables the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes, These records provide the basis for the compilation of nationality mortality and mobidity statistics by WHO member states.


The National Center for Health Statistics (NCHS) developed ICD-10-CM ( International Classification of Diseases, Tenth Revision, Clinical Modification) in consultation with a technical advisory panel, Physician groups, and clinical coders to assure clinical accuracy and utility. There are no codes for procedures in the ICD-10-CM and procedures are coded using the procedure classification appropriate for the encounter setting (eg, Current Procedural Terminology [cpt] and ICD-10-PCS).

ICD-10 includes 22 chapters for use; however, in the united states our clinical modification (CM) does not include the letter U. The letter U is not used for international data comparison and the codes are not being used in the united states.

ICD-10-CM is published in two sections:

1. Alphabetic Index or Index to Diseases and Injuries:
     Diagnostic terms organized in alphabetic order for the disease descriptions in the Tabular List. The terms Alphabetic Index and Index to Diseases and Injuries are used interchangeably throughout this text.

2. Tabular List :
     Diagnosis codes organized in numerical order and divided into chapters based on body system or condition.

ICD-10-CM is used by all coders to assign diagnosis codes that establish medical necessity for services rendered. In other words, diagnosis codes support why a service was rendered. For example, a patient has a bad cough and congestion. The provider performs a chest X-ray. On the claim form, the coder assigns diagnosis codes for the documented cough and congestion, which support the service. we will discuss the proper selection of ICD-10-CM codes later in this chapter.

Establishing medical necessity is the 1st step in third - party reimbursement. Payers require the following information to determine the need for care:

1. Knowledge of the emergent nature or severity of the patient's complaint or condition.
2. All signs, Symptoms, Complaints or background facts describing the reason for care, such as required follow-up care. These facts must be substantiated by the patient's medical record, which must be available to payers on request.

ICD-10-PCS includes procedure Codes and is typically used by facilities for inpatient services. Hospitalits use ICD-10-PCS in the outpatient facility for tracking purposes only and do not submit claims using ICD-10-PCS.