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A Primer on the Vocabularies of Meaningful Use – Procedure Vocabularies

June 30, 2010

By: Charlie Harp

Its Just a Simple Procedure… Current Procedure Terminology (CPT)

The Current Procedural Terminology (CPT) code set is maintained by the American Medical Association through the CPT Editorial Panel. The CPT code set accurately describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes. All CPT Codes are 5 digits.There are roughly 9200 CPT codes today. Here is an example of some CPT codes15788      CHEMICAL PEEL, FACIAL; EPIDERMAL15789      CHEMICAL PEEL, FACIAL; DERMAL15792 CHEMICAL PEEL, NONFACIAL; EPIDERMAL The code is not hierarchical but they do fall within defined numeric ranges called  sections. The use of CPT codes requires a license from the AMA. The main CPT page on the AMA site is located here. The Wikipedia page for CPT is located here. There is a good document covering the fundamentals of CPT coding here. CPT codes are in the UMLS metathesaurus, but you are required to have a CPT license to use them.


The International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) was developed as a replacement for the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) volume 3, Procedures.It is important to note that unlike the diagnosis and procedures subsets in ICD-9, ICD-10-CM and ICD-10-PCS are separate and distinct vocabularies.  They are not subsets of a holistic ICD-10.  This starts with the fact that the structure of a ICD-10-PCS code is not the same as a ICD-10-CM code.

ICD-10-PCS has a seven character alphanumeric code structure. Each character contains up to 34 possible values. Each value represents a specific option for the general character definition (e.g., stomach is one of the values for the body part character). The ten digits 0-9 and the 24 letters A-H,J-N and P-Z may be used in each character. The letters O and I are not used in order to avoid confusion with the digits 0 and 1.The second through seventh characters mean the same thing within each section, but may mean different things in other sections.In all sections, the third character specifies the general type of procedure per-formed (e.g., resection, transfusion, fluoroscopy), while the other characters give additional information such as the body part and approach. In ICD-10-PCS, the term “procedure” refers to the complete specification of the seven characters. I think the approach here is risky, primarily due to the limit of 34 items within each component of the smart key.  Many vocabularies have abandoned smart key system like this because of the complexity that is introduces when you need to add an item beyond the possible range (like #35…).

The reference manual for the ICD-10-PCS coding system can be downloaded here.

Wikipedia has a fairly robust ICD-10-PCS list and reference capability here.

You can download the latest ICD-10-PCS data files here.
(The file you want is the ‘2010 Code Descriptions – Long format, Table format’ zip file.)

There are roughly 72,000 ICD-10-PCS Codes. According to the American college of Emergency Physicians (ACEP), some preliminary inpatient hospital testing of ICD-10-PCS has indicated that the new procedure coding system is problematic to learn for both experienced and inexperienced coders. If this is true, it may be that CPT-4, which is also an anointed vocabulary, would be a better choice for procedures. The next post will be about allergy vocabularies.

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