Medical Code Set Development and Maintenance
ICD-10-CM is the HIPAA code set standard for reporting diagnoses in all healthcare settings. ICD-10-CM is a US clinical modification of the World Health Organization’s ICD-10. With a nuanced understanding of ICD-10-CM, health information professionals ensure the accuracy, protection, and accessibility of health information.
ICD-10-PCS is the HIPAA code set standard for reporting procedures performed on hospital inpatients and reported by hospitals. It is maintained by the Centers for Medicare & Medicaid Services (CMS).
The ICD-10 Coordination and Maintenance Committee (C&M) is a federal interdepartmental committee comprised of representatives from CMS and the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS). The committee is responsible for approving ICD-10-CM and ICD-10-PCS coding changes, developing errata, addenda, and other modifications.
Meetings are held twice a year, are open to the public, and provide a forum to discuss proposed changes to ICD-10-CM and ICD-10-PCS. For upcoming C&M meeting dates, deadlines, meeting materials (including meeting recordings), visit:
Current Procedural Terminology (CPT)
The CPT code set is Level I of the Healthcare Procedure Coding System (HCPCS) and is maintained by the American Medical Association. CPT is a HIPAA code set standard used primarily to identify medical services and procedures furnished by physicians and other healthcare professionals.
Healthcare Common Procedure Coding System (HCPCS) Level II Codes
HCPCS Level II is a standardized coding system that is used primarily to identify products, supplies, and services not included in CPT, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
HCPCS Level II is a HIPAA code set standard and is maintained by CMS. For more information about HCPCS Level II codes or how to request new or revised codes, visit the CMS website.
ICD-11 was developed by the World Health Organization (WHO) to replace ICD-10. The implementation date in the US is unknown.
Additional AHIMA Comments