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Medical Coding Systems
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Medical coding systems are fundamental to medical record keeping as well as to gathering and communicating public health statistics. They are used for a variety of purposes:
- recording causes of death
- coding diseases and procedures
- physician billing and reimbursement
Resources for five medical coding systems are covered in this guide:
International Classification of Diseases (ICD)
Diagnostic and Statistical Manual of Mental Disorders (DSM)
Current Procedural Terminology (CPT)
Diagnosis-Related Groups (DRG)
Resource-Based Relative Value Scale (RBRVS)
The International Classification of Diseases (ICD) is designed to promote international comparability in the collection, processing, classification, and presentation of mortality statistics. This includes providing a format for reporting causes of death on the death certificate.
Published under various titles since 1900, the ICD is a numeric classification system that arranges diseases and injuries into groups according to established criteria. It is copyrighted by the World Health Organization (WHO), which owns and publishes the classification.
The codes are revised approximately every 10 years by the WHO. Annual updates are published by the Health Care Financing Administration, now called the Centers for Medicare & Medicaid Services (CMS).
The ICD Finder on the CDC Web site allows keyword searching of ICD-9 and ICD-10.
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ICD-9-CM - International Classification of Diseases - Clinical Modification, 9th revision. Ann Arbor, Michigan: Commonwealth on Professional and Hospital Activities, 1978, 1980.
HSL Books WB 15 W929ca
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The ICD-9-CM, an adaptation of the ICD-9, is used in assigning codes to diagnoses associated with inpatient, outpatient, and physician office utilization in the United States. Volume 3 (procedures) is used in assigning codes associated with inpatient procedures. The ICD-9-CM is based on the ICD but provides for additional morbidity detail and is annually updated.
- ICD-9-CM Expert for Hospitals: International Classification of Diseases, 9th revision, Clinical Modification, 6th edition. Salt Lake City, UT: Ingenix, St. Anthony/Medicode
HSL Reference WB 15 W929cb (also available online in Stat!Ref)
- This is a handy reference for using the International Classification of Diseases, 9th Revision, a coding scheme for morbidity and mortality statistics; devised by an international committee under the auspices of the World Health Organization to ensure uniform data reporting; Clinical Modification (CM) is the U.S. adaptation which provides greater precision for maintaining clinical records
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ICD-10 - International Statistical Classification of Diseases and Related Health Problems, 10th revision, Geneva: World Health Organization, 1992-1994. (includes Vol.1: Tabular list. Vol.2: Instruction manual. Vol.3: Alphabetical index).
HSL Reference WB 15 W9292
- The 10th revision of the ICD uses an alphanumeric coding scheme based on codes with a single letter followed by two numbers at the three-character level (A00-Z99), whereas ICD-9 used numeric codes (001-999). This has significantly enlarged the number of categories available for the classification. Prior to being implemented in the U.S., it must pass through a variety of private and government committees, agencies, and organizations. Use of the ICD-10 has not yet been mandated in the U.S., although it is in wide use.
- ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva, Switzerland: World Health Organization, 1992.
HSL Reference WM 15 I61 1992
- The ICD-10 Classification of Mental and Behavioural Disorders is derived from Chapter V of the ICD-10 and presents a complete list of all mental and behavioural disorders. Besides giving the names of diseases and disorders, Chapter V has been further developed to give clinical descriptions and diagnostic guidelines.
A related classification, the International Classification of Diseases, Clinical Modification (ICD-10-CM), currently under development, is intended as a replacement for ICD-9-CM. It is an adaptation of the ICD-10 for use in the United States. For more information, see http://www.cdc.gov/nchs/about/major/dvs/icd10des.htm
The Diagnostic and Statistical Manual of Mental Disorders(DSM) provides numeric codes, diagnostic criteria, and comprehensive definitions of mental disorders.
- Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, 4th ed., Text Revision. Washington, DC: American Psychiatric Association, 2000.
HSL Reference WM 15 A512d (also available online in Stat!Ref)
- The Text Revision (TR) of the fourth edition incorporates information from a comprehensive literature review of research about mental disorders published since DSM-IV was completed in 1994. The codes and terms in DSM-IV are fully compatible with ICD-9-CM and ICD-10.
Current Procedural Terminology (CPT) is a listing of descriptive terms and five-digit identifying codes for reporting medical, surgical, and diagnostic services performed by physicians and other health care professionals. It first appeared in 1966 and is published annually by the American Medical Association.
- Current procedural terminology: CPT, Chicago, Ill.: American Medical Association, 1998-
HSL Reference W 15 A512 (also available online in Stat!Ref)
Diagnosis-Related Groups (DRG) are categories of clinically similar illnesses that require the same types of hospital resources to treat. Every patient can be classified into one of 511 categories.
- DRG Handbook. Baltimore, Md.: HCIA Inc.; Cleveland, Ohio : Ernst & Young, 1993-
HSL Reference WX 16 D778
- The DRG Handbook focuses on comparative hospital performance, providing a statistical picture of the 100 DRGs with the most Medicare discharges. By forecasting how much it will cost to treat a patient on the basis of the diagnosis (or DRG), rather than paying for treatment as it happens, the Medicare program executes its prospective payment system (PPS). The purpose of DRGs is to provide a framework for specifying case mix and to reduce hospital costs and reimbursements.
Resource-Based Relative Value Scales (RBRVS) are used to determine the resource costs of providing service to standardize how health care providers are reimbursed by Medicare.
- Medicare RBRVS: The Physicians' Guide. Chicago, IL: American Medical Association, c1993-
HSL Reference WT 31 M489
- Medicare reimburses physicians' services based on the RBRVS (Resource-Based Relative Value Scale), in which payments for services are determined by the resource costs needed to provide them. The cost of providing each service is divided into three components: physician work, practice expense, and professional liability insurance. The Medicare program applies the same payment schedule to every physician's service and every physician, with the exception of anesthesiologists.
- Essential RBRVS. Salt Lake City, UT: Ingenix, c2003-
HSL Reference W 74 AA1 M478
- The Essential RBRVS is a complete relative value schedule based on Medicare's RBRVS, which is used for the Medicare Physician Fee Schedule. The Medicare Physician Fee Schedule is not a complete schedule, however. Medicare does not pay for some services and does not assign relative values for other services, resulting in gaps in the schedule. This reference includes "gap" codes," those codes in the RBRVS not provided a RVU (Relative Value Unit) for Medicare. Also includes valuation of *HCPCS Level II codes.
- Relative Values for Physicians. Reston, VA: St. Anthony Publishing
HSL Reference W74 AA1 R382
- Provides values for physician services contained in the AMA's Current Procedural Terminology (CPT) system, as well as Medicare's HCPCS Level II codes.
*The Healthcare Common Procedure Coding System (HCPCS) includes Level I and Level II codes. Since Level I (CPT) does not contain all the codes needed to report medical services and supplies, the Centers for Medicare and Medicaid Services developed HCPCS Level II codes, which are updated annually by the CMS. They begin with a single letter followed by four numeric digits. For more information, see http://www.cms.hhs.gov/MedHCPCSGenInfo/.
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