Miracle on North Main Street and Miracle on Beacon Street


Join us for our holiday events on Dec. 9 from 12 to 2 p.m. Learn More

Blue Choice

South Carolina Healthy Connections

ICD-10

ICD-10-CM/PCS is the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It codes diseases, signs and symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease.  

ICD-10-CM is for diagnostic coding in all health care settings. ICD-10-PCS is for use in all inpatient hospital settings.

Why did the code set change? The industry has been using ICD-9 for over 30 years. ICD-9 allows only limited data about a patient’s medical conditions and hospital inpatient procedures. It has outdated terms and is inconsistent with current medical practice. There is also limited ability to create new codes to allow for medical advances.

Key Differences Between ICD-9 and ICD-10

There are many differences between the code sets. Here are a few to note:

  • Number of Codes Available — ICD-9 has about 13,000 codes, with limited space for additions. ICD-10 has more than 68,000 available codes. You can expand the codes to more than 72,000 codes by using optional sub-classifications.
  • Length of Codes — ICD-10 codes are longer. ICD-9 uses three to five digits, beginning with either a letter or a number and a decimal point after the third digit. ICD-10 codes are seven digits in length. The first three digits are similar to ICD-9 with a decimal point after the third digit. The digits that follow, however, have very specific meaning.
  • Specific Information — ICD-9 codes are based on outdated technology and a lack of specificity. ICD-10 reflects advances in medicine and medical technology, making the code set more relevant to today’s understanding of diagnoses. For example, you treat a patient for a burn on the right arm. The ICD-9 diagnosis code does not distinguish that the burn is on the right arm. The ICD-10 diagnosis code set can specify right versus left arm, initial encounter versus subsequent and other clinical information.

You can also find more information on the general ICD-10 page on the South Carolina Department of Health and Human Services site as well as in the latest press release.

Contact Us
The EDI Solutions Help Desk is available Mondays - Fridays from 8 a.m. to 4:30 p.m. EST.
Phone: 1-800-470-9630
Email: BlueChoiceSCEDI@wellpoint.com