In-Depth Analysis: Purpose, Function, and Transition to ICD-10-PCS

This assignment provides a detailed explanation of the ICD-10-PCS coding system, including its purpose, function, and the reasons for the transition from ICD-9 Vol. 3. It discusses the four major goals of ICD-10-PCS development and evaluates their value to inpatient coders, emphasizing the importance of improved communication with physicians. The assignment also explores the use of ICD-10-CM in the United States and its differences in application compared to other countries, highlighting the value of tracking epidemiological trends. Furthermore, it addresses potential reasons for insurance claim denials, differentiates between GERD and bleeding ulcers, and provides advice on resolving billing issues. The assignment concludes by explaining the function of ICD-10-CM coding guidelines and the impact of incorrect coding on patients and society, supported by relevant references. Desklib provides access to this assignment and a wealth of other study resources for students.

Running head: MEDICAL CODING 1
Medical Coding
Name
Institution

MEDICAL CODING 2
Medical Coding
Part #1
Explain the purpose and function of the ICD-10-PCS coding system, include reasons for
the transition from ICD-9 Vol. 3.
In essence, ICD-10 Procedure Coding System (ICD-10-PCS) is considered as an
international system of medical classification often used for procedural coding system. This
system was designed to replace Volume 3 of ICD-9-CM. Consequently, this system is meant to
assign codes to procedures that are associated with hospital utilization in various countries such
as the United State (Centers for Medicare and Medicaid Services (CMS), 2014). Additionally,
ICD-10-PCS is used to support a collection of data, payment as well as an electronic health
record. The main reason for the transitioning from ICD-9 Vol. 3 to ICD-10-PCS was the fact that
the later could accommodate new diagnosis as well as procedure codes for future clinical
protocols. Primarily, this could improve the overall quality measurements, patient’s safety as
well as medical processes outcomes.
Which of the four major goals used for the development of ICD-10-PCS do you think is the
most valuable to inpatient coders? Explain your answer.
Ideally, the main goals for the development of the ICD-10-PCS were to improve the
overall accuracy as well as the efficiency of procedure coding, to replace the ICD-9-CM coding
system with a rather more logical system. Additionally, it makes sure that communication with
physicians is improved through developing a code system which is aligned more with the overall
clinical aspects surrounding a variety of procedures, and give coders a chance to create accurate
codes with little efforts involves (Centers for Medicare and Medicaid Services (CMS), 2014).
However, the most valuable goals are to make sure that communication with physicians are

MEDICAL CODING 3
improved through developing a code system which is aligned more with the overall clinical
aspects surrounding a variety of procedures because it is ensured that patients are accorded
quality health care system.
Do you think inpatient coders will need to have a more in-depth understanding of anatomy
and medical terminology to use the ICD-10-PCS coding system? Why or why not.
Primarily, coders are not supposed to have a rather in-depth knowledge of anatomy as
well as medical terminology because the ICD-10-PCS system is anatomically detailed regarding
clinical data; therefore, reducing coder’s anxiety as it captures procedural description in detail
(Subotin & Davis, 2014).
Part #2
Explain the purpose for using the ICD-10-CM in the United States?
The main purpose of the ICD-10-CM system is used by the healthcare providers as well
as physicians to classify while coding all the necessary diagnoses, symptoms and procedures that
are recorded in conjunction with hospital care system in the United States.
How is the ICD-10 coding system used differently in other countries?
While this system has been embraced in more than 100 countries around the world, the
applicability of this system is different as other countries do not code further than the 5th
character. Consequently, no other country can get close to the 69,000 codes that are currently
used in the United States (Centers for Medicare and Medicaid Services (CMS), 2014).
Which designated purposes for use in the US do you think are the most valuable? Explain
your answer.
One of the most valuable purposes of the ICD-10 in the US is to track virtually all
epidemiological trends in the health care system. This is because the coders, physicians, and the

MEDICAL CODING 4
healthcare profession can be on the toe with the required treatment procedure of an emerging
illness.
Part #3
Why do you think the insurance company is denying your friend’s claim?
Some of the ways that an insurance company may deny a claim of a friend are by saying
that the accident was a personal fault that contributed to the accident or even another party that is
included in another policy was at fault (Subotin & Davis, 2014).
Explain the biller’s assigned diagnosis code of GERD and how it is different than the
bleeding ulcer of the esophagus the physician treated. Include any symptoms that are
similar between the two diagnoses.
GERD diagnosis code is a system used to diagnose a digestive disorder that is known to
affect the lower esophageal sphincter. On the other hand, ulcers are treated by the use of acid-
blocking drugs that are called proton pump inhibitors.
What advice will you give your friend about how to get th********** paid**********ART
To make a payment regarding the above mentioned, I would advise the friend to follow
the guidelines that are provided by ICD-10-PCS (Centers for Medicare and Medicaid Services
(CMS), 2014).
Explain the function of the ICD-10-CM coding guidelines and how they affect code
assignment?
It provides a better data collection; therefore, improving the value-based reimbursement,
outcome of the overall measures, and reporting new and existing medical terminologies (Subotin
& Davis, 2014). In this light, they affect the code assignment by creating a more precision in the
treatment process.

MEDICAL CODING 5
Describe two ways assigning incorrect codes can affect a patient.
Some effect of assigning a wrong code to a patient is that it may cause injuries and even
death to patients.
Describe two ways assigning incorrect codes can affect society. (CDC)
Primarily, assigning a wrong code can result in a rather wrong diagnosis to people in
society as well as improper treatment procedures.

MEDICAL CODING 6
References
Centers for Medicare and Medicaid Services (CMS). (2014). 2010 ICD-10-PCS Code Tables and
Index. Webiste: www. cms. gov/Medicare/Coding/ICD10/2014-ICD-10-PCS. html.
Accessed March, 20.
Subotin, M., & Davis, A. (2014). A system for predicting ICD-10-PCS codes from electronic
health records. Proceedings of BioNLP 2014, 59-67.