--- title: "ICD-10-CM / ICD-10-PCS, Definition | MedTech Terms" description: "Diagnosis (CM) and inpatient procedure (PCS) coding systems used in U.S. claims. Plain-English Reimbursement definition for MedTech teams, with examples and rel" lang: en json-ld: | { "@context": "https://schema.org", "@graph": [ { "@type": "DefinedTerm", "@id": "https://medtechterms.com/terms/icd-10#term", "name": "ICD-10-CM / ICD-10-PCS", "description": "ICD-10-CM codes are diagnosis codes used across all care settings; ICD-10-PCS codes describe inpatient procedures and drive MS-DRG assignment for hospital reimbursement.", "url": "https://medtechterms.com/terms/icd-10", "termCode": "icd-10", "inDefinedTermSet": { "@type": "DefinedTermSet", "name": "MedTech Terms", "url": "https://medtechterms.com/terms" } }, { "@type": "Article", "@id": "https://medtechterms.com/terms/icd-10#article", "headline": "ICD-10-CM / ICD-10-PCS", "description": "Diagnosis (CM) and inpatient procedure (PCS) coding systems used in U.S. claims.", "url": "https://medtechterms.com/terms/icd-10", "mainEntityOfPage": { "@type": "WebPage", "@id": "https://medtechterms.com/terms/icd-10" }, "about": { "@id": "https://medtechterms.com/terms/icd-10#term" }, "articleSection": "Reimbursement", "inLanguage": "en", "keywords": "ICD-10-CM / ICD-10-PCS, Reimbursement, medical device, MedTech", "author": { "@type": "Person", "name": "Christian Espinosa", "jobTitle": "Founder, Blue Goat Cyber", "url": "https://bluegoatcyber.com" }, "publisher": { "@type": "Organization", "name": "MedTech Terms", "url": "https://medtechterms.com" }, "isPartOf": { "@type": "WebSite", "name": "MedTech Terms", "url": "https://medtechterms.com" }, "datePublished": "2026-05-05", "dateModified": "2026-05-05", "citation": [ { "@type": "CreativeWork", "name": "CMS ICD-10", "url": "https://www.cms.gov/medicare/coding-billing/icd-10-codes", "publisher": { "@type": "Organization", "name": "CMS" } }, { "@type": "CreativeWork", "name": "AMA CPT Resources", "url": "https://www.ama-assn.org/practice-management/cpt", "publisher": { "@type": "Organization", "name": "AMA" } }, { "@type": "CreativeWork", "name": "AdvaMed - Payment & Coverage", "url": "https://www.advamed.org/our-work/", "publisher": { "@type": "Organization", "name": "AdvaMed" } } ], "mentions": [ { "@type": "DefinedTerm", "@id": "https://medtechterms.com/terms/cpt#term", "name": "Current Procedural Terminology Codes", "alternateName": "CPT", "url": "https://medtechterms.com/terms/cpt" }, { "@type": "DefinedTerm", "@id": "https://medtechterms.com/terms/hcpcs#term", "name": "HCPCS Codes", "alternateName": "HCPCS", "url": "https://medtechterms.com/terms/hcpcs" } ] }, { "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": 1, "name": "Home", "item": "https://medtechterms.com/" }, { "@type": "ListItem", "position": 2, "name": "Terms", "item": "https://medtechterms.com/terms" }, { "@type": "ListItem", "position": 3, "name": "Reimbursement", "item": "https://medtechterms.com/terms?cat=Reimbursement" }, { "@type": "ListItem", "position": 4, "name": "ICD-10-CM / ICD-10-PCS", "item": "https://medtechterms.com/terms/icd-10" } ] }, { "@type": "FAQPage", "@id": "https://medtechterms.com/terms/icd-10#faq", "mainEntity": [ { "@type": "Question", "name": "How do regulatory professionals interact with ICD-10 codes?", "acceptedAnswer": { "@type": "Answer", "text": "Regulatory professionals monitor the development of new ICD-10 codes, particularly ICD-10-PCS, to ensure that their MedTech products can be appropriately coded for reimbursement and data tracking. They may engage in the CMS coordination and maintenance process to advocate for new codes relevant to their devices." } }, { "@type": "Question", "name": "Are ICD-10 codes related to product classification?", "acceptedAnswer": { "@type": "Answer", "text": "While not directly a product classification system like those used by the FDA, ICD-10 codes describe the conditions treated by or procedures performed with MedTech products. Adequate coding ensures proper identification of medical necessity and utilization." } }, { "@type": "Question", "name": "What is the significance of the CMS ICD-10 Coordination & Maintenance meetings?", "acceptedAnswer": { "@type": "Answer", "text": "These public meetings are where new and revised ICD-10 codes are discussed and approved. For MedTech companies, these meetings represent a crucial opportunity to advocate for codes that accurately reflect their innovative technologies and ensure appropriate reimbursement." } }, { "@type": "Question", "name": "Do other countries use ICD-10 codes?", "acceptedAnswer": { "@type": "Answer", "text": "Many countries use some form of ICD, which is maintained by the World Health Organization (WHO) for mortality and morbidity statistics. However, specific implementation and usage, such as for reimbursement, can vary significantly by country. ICD-10-CM and ICD-10-PCS are US-specific adaptations." } } ] } ] } --- [ MedTech Terms The authoritative reference ](/) Browse Learn [Latest](/latest) About 1. [Home](/) 2. / 3. [Terms](/terms) 4. / 5. [Reimbursement](/terms?cat=Reimbursement) 6. / 7. ICD-10-CM / ICD-10-PCS [All terms](/terms) Reimbursement [Hospital Buyer & Reimbursement](/ecosystems/hospital-buyer) # ICD-10-CM / ICD-10-PCS Diagnosis (CM) and inpatient procedure (PCS) coding systems used in U.S. claims. Reviewed by [Christian Espinosa, Founder, Blue Goat Cyber](/authors/christian-espinosa) Last reviewed May 5, 2026 ## Definition ICD-10-CM codes are diagnosis codes used across all care settings; ICD-10-PCS codes describe inpatient procedures and drive [MS-DRG](/terms/ms-drg) assignment for hospital reimbursement. What the regulation says ICD-10-CM codes are used for reporting diagnoses across all healthcare settings, as mandated by the [Health Insurance Portability and Accountability Act](/terms/hipaa) (HIPAA) for electronic transactions. ICD-10-PCS codes are specifically for reporting inpatient procedures and are critical for reimbursement under systems like Medicare Severity-Diagnostic Related Groups (MS-DRGs) in the United States, as managed by the Centers for Medicare and Medicaid Services (CMS). The correct application of these codes directly impacts billing, data collection, and public health reporting. ## What this means in practice Securing a unique ICD-10-PCS code can materially change inpatient payment for a new procedure or device. CMS holds public ICD-10 Coordination & Maintenance meetings twice yearly. ## Examples - A MedTech manufacturer develops a novel surgical implant; they must ensure that a corresponding ICD-10-PCS code exists or is proposed to ensure hospitals can bill for its use effectively. - A regulatory affairs specialist reviews clinical study data to identify diagnoses that will be reported using ICD-10-CM codes, verifying alignment with the intended use and claims for the device. - During post-market surveillance, ICD-10-CM codes associated with device complications or adverse events are analyzed to identify potential trends or issues. Common pitfalls - • Assuming that a MedTech product automatically receives a unique ICD-10-PCS code without active engagement in the CMS coordination and maintenance process is a common mistake. - • Failing to understand the specific criteria and timelines for proposing new ICD-10 codes can lead to delayed market access or suboptimal reimbursement for new technologies. - • Incorrectly coding diagnoses (ICD-10-CM) or procedures (ICD-10-PCS) can result in claim denials, audits, and potential penalties. - • Overlooking the distinction between ICD-10-CM for diagnoses and ICD-10-PCS for inpatient procedures can lead to mischaracterization of a device’s impact or use. ## Frequently asked questions How do regulatory professionals interact with ICD-10 codes? Regulatory professionals monitor the development of new ICD-10 codes, particularly ICD-10-PCS, to ensure that their MedTech products can be appropriately coded for reimbursement and data tracking. They may engage in the CMS coordination and maintenance process to advocate for new codes relevant to their devices. Are ICD-10 codes related to product classification? What is the significance of the CMS ICD-10 Coordination & Maintenance meetings? Do other countries use ICD-10 codes? ## Cross-references ### See also Closely related context worth reading. - [ Current Procedural Terminology Codes(CPT) ](/terms/cpt) ## Related terms Grouped by theme ### Editor's picks · Hand-selected related concepts [ Reimbursement HCPCS Codes(HCPCS) CMS-maintained codes for products, supplies, and services not in CPT. ](/terms/hcpcs)[ Reimbursement Current Procedural Terminology Codes(CPT) AMA-maintained codes used to report medical procedures and services for billing. ](/terms/cpt) ### Reimbursement & Market Access · From this learning path [ Reimbursement National and Local Coverage Determinations(NCD / LCD) Medicare coverage policies issued nationally (NCD) or by individual MAC contractors (LCD). Adjacent lesson ](/terms/ncd-lcd?from=reimbursement-and-market-access)[ Reimbursement Budget Impact Model(BIM) Financial model that estimates the total cost consequences of adopting a new technology to a payer's budget over a defined horizon. ](/terms/budget-impact-model?from=reimbursement-and-market-access)[ Reimbursement CPT Codes(CPT) AMA-maintained codes that describe medical procedures and services. ](/terms/cpt-codes?from=reimbursement-and-market-access)[ Reimbursement Health Technology Assessment(HTA) Systematic evaluation of clinical and economic value of a health technology. ](/terms/hta?from=reimbursement-and-market-access) ### More in Reimbursement · Same category [ Reimbursement LCD and NCD Local and National Coverage Determinations from Medicare. ](/terms/lcd-ncd)[ Reimbursement Medicare Administrative Contractor(MAC) Private contractors that process Medicare Part A/B and DME claims and issue Local Coverage Determinations within their jurisdictions. ](/terms/mac) Cited by Where this term appears across MedTech Terms. Learning paths (1) - [Reimbursement & Market Access](/paths/reimbursement-and-market-access)Lesson 4 of 14 Ecosystems (1) - [Hospital Buyer & Reimbursement](/ecosystems/hospital-buyer) ## Primary references 3 sources Link health: 3 verified · last checked 2026-06-20 CMS· 1 AMA· 1 AdvaMed· 1 1. [1 CMS ICD-10 Verified CMS · cms.gov ](https://www.cms.gov/medicare/coding-billing/icd-10-codes) 2. [2 AMA CPT Resources Verified AMA · ama-assn.org ](https://www.ama-assn.org/practice-management/cpt) 3. [3 AdvaMed - Payment & Coverage Verified AdvaMed · advamed.org ](https://www.advamed.org/our-work/) Inline markers like \[1\] jump to the matching reference above. Sponsor note ### Need cybersecurity expertise on a connected-device launch? Blue Goat Cyber helps MedTech teams ship connected products that hospital security teams will actually procure. [Book a 30-minute discovery session](https://go.bluegoatcyber.com/meetings/blue-goat-cyber/discovery-session) - No obligation - Expert-led from minute one - NDA available on request MedTech Terms is a community resource sponsored by [Blue Goat Cyber](https://bluegoatcyber.com). Definitions are independent of any vendor. On this term Category Reimbursement Sources 3 Updated 5/5/2026 [Compare with another term](/compare?a=icd-10) Learn in 60 seconds Card Lesson Quiz Diagnosis (CM) and inpatient procedure (PCS) coding systems used in U.S. claims. - · Securing a unique ICD-10-PCS code can materially change inpatient payment for a new procedure or device. - · CMS holds public ICD-10 Coordination & Maintenance meetings twice yearly. Remember this Watch out: Assuming that a MedTech product automatically receives a unique ICD-10-PCS code without active engagement in the CMS coordination and maintenance process is a common mistake. Related terms - [Current Procedural Terminology Codes(CPT) ](/terms/cpt) - [HCPCS Codes(HCPCS) ](/terms/hcpcs) You may also need Auto-suggested from Reimbursement and shared keywords. - [MS-DRG(MS-DRG) ](/terms/ms-drg) - [Ambulatory Payment Classification(APC) ](/terms/apc) - [ASC Site-of-Service Shift ](/terms/asc-shift) - [CPT Codes(CPT) ](/terms/cpt-codes) - [Inpatient Prospective Payment System(IPPS) ](/terms/ipps) - [Bundled Payment ](/terms/bundled-payment) [All Reimbursement terms](/terms?cat=Reimbursement) MedTech Terms An authoritative, plain-language reference for the regulatory, quality, cybersecurity, and software terms that shape modern medical devices. Browse - [All terms](/terms) - [A–Z index](/a-z) - [Categories](/categories) - [Ecosystems](/ecosystems) - [Learning paths](/paths) - [Compare terms](/compare) - [Quiz](/quiz) Resources - [FDA Medical Devices](https://www.fda.gov/medical-devices) - [EU MDR](https://eur-lex.europa.eu/eli/reg/2017/745/oj) - [IMDRF](https://www.imdrf.org/) - [Methodology](/methodology) - [Changelog](/changelog) - [Editor: Christian Espinosa](/authors/christian-espinosa) - [About this site](/about) © 2026 MedTech Terms. Reference content for educational purposes - not regulatory advice. A community resource sponsored by [Blue Goat Cyber](https://bluegoatcyber.com)