ICD-10-PCS

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ICD-10-PCS

• Beginning The Journey

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ICD-10-PCS Structure

• ICD-9-CM

• ICD-10-PCS

• ICD-9-CM has 3-4 characters
• All characters are numeric
• All codes have at least 3 characters

• ICD-10-PCS has 7 characters
• Each can be either alpha or numeric
• Numbers 0-9 letters A-H, J-N, P-Z
• Alpha characters are not case-sensitive
• Each code must have 7 characters

ICD-10 AHIMA
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ICD-10-PCS - Structure

• ICD-9-CM

.
X
X
X
X
1
2
4
3

• ICD-10-PCS

X
X
X
X
X
X
X
3
E
0
4
F
8
0
1
0
H
Z
0
7
3
0
D
B
X
5
8
Z
ICD-10 AHIMA
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WHAT IS A ROOT OPERATION????

• THE OBJECTIVE
• OR
• ACTION OF THE PROCEDURE

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31 MEDICAL SURGICAL ROOT OPERATIONS

• There is a specific definition for each one of
  these roots
• ICD-10-PCS uses terminology that coders are not
  accustomed to seeing on a chart
• The purpose of this training is to help the coder
  smoothly transition to the new root operation and
  their meanings

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SURGICAL MEDICAL ROOT OPERATIONS (31)
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
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ICD-10-PCS - Structure Characters (Med/Surg)
1
2
3
4
5
6
7
Root Operation
Qualifier
Section
Approach
Body System
Body Part
Device
ICD-10 AHIMA
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First Character of the Procedure Code -Section

• 0 - Medical and Surgical
• 1 Obstetrics
• 2 Placement
• 3 - Administration
• 4 Measurement and Monitoring
• 5 Extracorporeal Assistance and Performance
• 6 Extracorporeal Therapies
• 7 Osteopathic
• 8 Other Procedures
• 9 Chiropractic
• B Imaging
• C Nuclear Medicine
• D Radiation Oncology
• F Physical Rehabilitation and Diagnostic
  Audiology
• G Mental Health
• H Substance Abuse Treatment

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Medical and Surgical section

• Largest of the 16 sections
• Same definition or meaning
• Section BD and F-H comprise the Ancillary
  section of ICD-10-PCS

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Sec Second Character- Body System

• General physiological system or anatomical region
  involved

Body System Value
Central Nervous 0
Peripheral Nervous 1
Heart and Great Vessels 2
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Third Character Root Operation

• Objective of the procedure
• 31 Root Operations

Examples of Root Operations
Bypass
Resection
Excision
Removal
12
Fourth Character Body Part

• Defines the body part or specific anatomical site
  where the procedure was performed
• This is different from character 2 which provides
  the general Body System
• There are 34 possible body part values in each
  body system

Examples of Body Parts are
Liver
Kidney
Ascending Colon
Optic Nerve
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Fifth Character - Approach

• Defines the approach, or the technique used to
  reach the procedure site
• There are seven different approach values in the
  Medical and Surgical section

Through Skin or mucous membrane Through an orifice External
Open Natural or Artificial Opening
Percutaneous Natural or Artificial Opening Endoscopic
Percutaneous Endoscopic Natural or Artificial Opening with Percutaneous Endoscopic Assistance
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Sixth Character - Devices

• Identified devices that remain after the
  procedure is completed
• Remember that all codes require seven characters
• The default value to indicate that NO device was
  involved is Z

Examples of Device Values
Drainage Device
Radioactive Element
Extraluminal device
Intraluminal device
Autologous tissue substitute
Synthetic substitute
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Seventh Character - Qualifier

• Qualifier for the code that provides additional
  information about a specific attribute of the
  procedure
• These qualifiers may have a narrow application,
  to a specific root operation, body system or body
  part
• Most procedures will not have an applicable
  qualifier. The default value for NO qualifier is
  a Z

Examples of Qualifiers
Type of Transplant
Second site for a bypass
Diagnostic excision (biopsy)
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EXAMPLE CODE

• 0LB50ZZ Excision of right lower arm and wrist
  tendon, open 0 Section Medical and
  Surgical
• L Body Section - Tendons
• B Root Operation- Excision
• 5 Body Part Lower arm and wrist tendon,
  right
• 0 Approach - Open
• Z Device No Device
• Z Qualifier No Qualifier

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CODERS MUST LEARN NEW TERMINOLOGY

• It is the coders responsibility to determine
  which root operation the documentation in the
  medical record equates to in the PCS definitions

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PHYSICIAN TERMINOLOGY MAY NOT CHANGE

• The physician is not expected to use the root
  terms provided in PCS code description
• Nor
• Is the coder required to query the physicians
  when the correlation between the documentation
  and the defined PCS term is clear.

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EPONYMS ARE GONE IN ICD 10 PCS

• Billroth I procedure equates to
  anastomosis

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QUESTIONS