2010 UBO/UBU Conference

Title: ICD-10-PCS General Guidelines

Session: T-5-1100

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Objectives

History of ICD-10-PCS Code Structure Conventions General Guidelines

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History of ICD-10 PCS

CMS is the responsible agency for maintaining the inpatient procedure code set

Contracted with 3M in 1993 to develop the clinical modification for ICD-10, replacing volume 3 of ICD-9-CM

Initially completed in 1998 and updated annually ICD-10-PCS for 2010 has 71,957 separate procedure

codes

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History of ICD-10 PCS

ICD-10-PCS incorporated the following major attributes: Completeness – all substantially different procedures

have a unique code Unique definitions – codes are constructed with

individual “values” instead of lists of fixed codes Expandability – the structure of the system allows

incorporation of new procedures as unique codes

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History of ICD-10 PCS

Standardized terminology– Includes definitions of the terminology used. While the

meaning of specific words can vary in common usage, ICD-10-PCS defines a single meaning for each term used in the system

Multi-axial – The system has a multi-axial structure– Each character has the same meaning within a

section and across sections to the extent possible

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History of ICD-10 PCS

Structural Integrity – easily expandable without disrupting structural integrity using variable “value” combinations

Diagnostic information is not included in procedure description

Restricted use of NOS – must have a minimal level of specificity for each component

Limited use of NEC – only when necessary Level of specificity – unique codes are available for

variations of procedures

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Code Structure

Codes are comprised of seven components– Each component is called a “character” all codes are

seven characters long Individual units for each character are represented by a

letter or number – Each unit is called a “value”

34 possible values for each character– Digits 0- 9 and letters A-H, J-N, P-Z– No use of letters I and O to avoid confusion with the

numbers 1 and 0

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Code Structure

Example of Code Structure Characters:

Section Body System

Root Operation

Body Part

Approach Device Qualifier

1 2 3 4 5 6 7

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Procedure – First Character

Medical and Surgical = 0 Obstetrics = 1

Placement = 2 Administration = 3

Measuring and Monitoring = 4 Extracorporeal Assistance and Performance = 5

Extracorporeal Therapies = 6 Osteopathic = 7

Other Procedures = 8 Chiropractic = 9

Imaging = B Nuclear Medicine = C

Radiation Oncology = D Physical Rehabilitation andDiagnostic Audiology = F

Mental Health = G Substance Abuse Treatment = H

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Body Systems – Second Character

Central Nervous System = 0 Peripheral Nervous System = 1

Heart and Great Vessels = 2 Upper Arteries = 3

Lower Arteries = 4 Upper Veins = 5

Lower Veins = 6 Lymphatic and Hemic Systems = 7

Eye = 8 Ear, Nose, Sinus = 9

Respiratory System = B Mouth and Throat = C

Gastrointestinal System = D Hepatobiliary System and Pancreas = F

Endocrine System = G Skin and Breast = H

Subcutaneous Tissue and Fascia = J Muscles = K

Tendons = L Bursae and Ligaments = M

Head and Facial Bones = N Upper Bones = P

Lower Bones = Q Upper Joints = R

Lower Joints = S Urinary System = T

Female Reproductive System = U Male Reproductive System = V

Anatomical Regions, General = W Anatomical Regions, Upper Extremities = X

Anatomical Regions, Lower Extremities = Y

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Definitions of Root Operations – Third Character

31 different root operation values– Each root operation identifies a precise and distinct

objective Alteration: Modifying the anatomic structure of a body

part without affecting the function of the body part– Breast augmentation

Bypass: Altering the route of passage of the contents of a tubular body part– Coronary artery bypass

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Definitions of Root Operations – Third Character

Change: Taking out or off a device from a body part and putting back an identical or similar device in or on the same body part without cutting or puncturing the skin or a mucous membrane– Gastrostomy tube change

Control: Stopping, or attempting to stop, post procedural bleeding– Control of post-tonsillectomy hemorrhage

Creation: Making a new genital structure that does not take over the function of a body part– Creation of penis in a female

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Definitions of Root Operations – Third Character

Destruction: Physical eradication of all or a portion of a body part by the direct use of energy, force, or a destructive agent– Fulguration of rectal polyp

Detachment: Cutting off all or a portion of the upper or lower extremities– Below knee amputation

Dilation: Expanding an orifice or the lumen of a tubular body part– Percutaneous transluminal angioplasty

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Definitions of Root Operations – Third Character

Division: Cutting into a body part, without draining fluids and/or gases from the body part, in order to separate or transect a body part– Osteotomy

Drainage: Taking or letting out fluids and/or gases from a body part– Incision and drainage

Excision: Cutting out or off, without replacement, a portion of a body part– Liver biopsy

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Definitions of Root Operations – Third Character

Extirpation: Taking or cutting out solid matter from a body part– Thrombectomy

Extraction: Pulling or stripping out or off all or a portion of a body part by the use of force– Dilation and curettage

Fragmentation: Breaking solid matter in a body part into pieces– Transurethral lithotripsy

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Definitions of Root Operations – Third Character

Fusion: Joining together portions of an articular body part rendering the articular body part immobile– Spinal fusion

Insertion: Putting in a nonbiological appliance that monitors, assists, performs, or prevents a physiological function but does not physically take the place of a body part– Insertion of central venous catheter

Inspection: Visually and/or manually exploring a body part– Diagnostic arthroscopy

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Definitions of Root Operations – Third Character

Map: Locating the route of passage of electrical impulses and/or locating functional areas in a body part– Cardiac mapping

Occlusion: Completely closing an orifice or the lumen of a tubular body part– Fallopian tube ligation

Reattachment: Putting back in or on all or a portion of a separated body part to its normal location or other suitable location– Reattachment of hand

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Definitions of Root Operations – Third Character

Release: Freeing a body part from an abnormal physical constraint– Carpal tunnel release

Removal: Taking out or off a device from a body part– Cardiac pacemaker removal

Repair: Restoring, to the extent possible, a body part to its normal anatomic structure and function– Suture of laceration

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Definitions of Root Operations – Third Character

Replacement: Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part– Free skin graft

Reposition: Moving to its normal location, or other suitable location, all or a portion of a body part– Fracture reduction

Resection: Cutting out or off, without replacement, all of a body part– Total lobectomy of lung

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Definitions of Root Operations – Third Character

Restriction: Partially closing an orifice or the lumen of a tubular body part– Cervical cerclage

Revision: Correcting, to the extent possible, a portion of a malfunctioning device or the position of a displaced device– Adjustment of hip prosthesis

Supplement: Putting in or on biological or synthetic material that physically reinforces and/or augments the function of a portion of a body part– Herniorrhaphy using mesh

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Definitions of Root Operations – Third Character

Transfer: Moving, without taking out, all or a portion of a body part to another location to take over the function of all or a portion of a body part– Skin pedicle flap transfer

Transplantation: Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and/or function of all or a portion of a similar body part– Kidney transplant

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Definitions of Root Operations – Third Character

The root operation is coded according to the objective of the procedure actually performed– Discontinued or modified procedures are coded to

procedure actually performed Composite terms (e.g., colonoscopy, sigmoidectomy) are

not root operations – coded as inspection Combination procedures are coded separately. Each

procedure with a distinct objective during an operative episode is coded separately

The complete or partial redo of a procedure is coded to the root operation performed rather than revision

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Body Part – Fourth Character

The specific part of the body system where the procedure was performed

Tubular body parts are defined as those hollow body parts that provide a route of passage for solids, liquids, or gases– e.g., CV system, GI tract, respiratory tract

If a procedure is performed on a portion of a body part that does not have a separate body part value, code the body part value corresponding to the whole body part– A procedure performed on the alveolar process of the

mandible is coded to the mandible body part

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Approach – Fifth Character

Seven different approach values– Open: cutting through the skin or mucous membrane

and any other body layers necessary to expose the site of the procedure

– Percutaneous: entry by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure

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Approach – Fifth Character

– Percutaneous Endoscopic: entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedure

– Via Natural or Artificial Opening: entry of instrumentation through a natural or artificial external opening to reach the site of the procedure

– Via Natural or Artificial Opening Endoscopic: entry of instrumentation through a natural or artificial external opening to reach and visualize the site of the procedure

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Approach – Fifth Character

– Via Natural or Artificial Opening Endoscopic with Percutaneous Endoscopic Assistance: entry of instrumentation through a natural or artificial external opening to reach and visualize the site of the procedure, and entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to aid in the performance of the procedure

– External: procedures performed directly on the skin or mucous membrane and procedures performed indirectly by the application of external force through the skin or mucous membrane

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Approach – Fifth Character

The approach comprises three components: the access location, method, and type of instrumentation

Access location: two general types of access locations– Skin or mucous membranes

All open and percutaneous values– External orifices

Either Natural or artificial openings

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Approach – Fifth Character

Method: Specifies how the external access location is entered for procedures performed on an internal body part

Type of Instrumentation: When specialized equipment is used to perform the procedure

Appendix C of ICD-10-PCS compare the components of each approach

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Device – Sixth Character

Only used to specify devices that remain after the completed procedure– Biological or synthetic material that takes the place of

all or portion of a body part (skin graft, joint prosthesis)

– Biological or synthetic material that assists or prevents a physiological function (IUD)

– Therapeutic material that is not absorbed by, eliminated by, or incorporated into a body part (radioactive implant)

– Mechanical or electronic appliances used to assist, monitor, take the place of, or prevent a physiological function (pacemaker, orthopedic pins)

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Qualifier – Seventh Character

Contains unique values for individual procedures– Example: Identifies the destination site in a bypass

Lower Vein Bypass, “6” = Inferior Mesenteric Vein 06104Z6 (0-M&S, 6-Lower Veins, 1-Bypass)

Body Part (4)

Approach (5) Device (6) Qualifier (7)

0 Inferior Vena Cava

0 Open4 Percutaneous Endoscopic

7 Autologous Tissue Substitute9 Autologous Venous TissueA Autologous Arterial TissueJ Synthetic SubstituteK Nonautologous Tissue SubstituteZ No Device

5 Superior Mesenteric Vein6 Inferior Mesenteric VeinY Lower Vein

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Qualifier – Seventh Character

– Specific orthopedic terms: Insertion of External Fixation Device, “9” = Limb Lengthening

Device 0PHC359 (0-M&S, P-Upper Bones, H-Insertion)

Body Part (4) Approach (5) Device (6) Qualifier (7)

Long list…C Humeral Head, Right

0 Open3 Percutaneous4 Percutaneous

Endoscopic

5 External Fixation Device

3 Monoplanar4 Ring5 Hybrid9 Limb Lengthening DeviceZ No Qualifier

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Index

Codes in the index are based on the general type of procedure (e.g., resection, fluoroscopy)

Provides the first three or four values of the code values The tables must always be used to obtain the complete

code No eponyms are included (e.g., Heller Operation

[Esophagomyotomy])

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Index

Fasciaplasty, fascioplasty

see Repair, Subcutaneous Tissue and Fascia 0JQ

see Replacement, Subcutaneous Tissue and Fascia 0JR

Fasciectomy see Excision, Subcutaneous Tissue and Fascia

0JB

Fasciorrhaphy see Repair, Subcutaneous Tissue and Fascia

0JQ

Fasciotomy

see Division, Subcutaneous Tissue and Fascia 0J8

see Drainage, Subcutaneous Tissue and Fascia 0J9

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Code Tables

Procedure codes must be chosen from Code Tables– Characters 1-3 located at the top of the table are the

first three characters of the procedure code: section name, body system and root operation (Medical and Surgical)

Each table contains four columns and varying numbers of rows

Column: Specifies the allowable values for characters 4-7

Row: Specifies the valid combinations of values which are the last four characters of the procedure code

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Code Table Example

Section 0 Medical and SurgicalBody System 4 Lower ArteriesOperation J Inspection: Visually and/or manually exploring a body part

Body Part Approach Device Qualifier

Y Lower Artery 0 Open 3 Percutaneous 4 Percutaneous Endoscopic X External

Z No Device Z No Qualifier

04JY4ZZ = Explore Right Peroneal Artery

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Code Table Example

Section 0 Medical and SurgicalBody System 4 Lower Arteries Operation P Removal: Taking out or off a device from a body part

Body Part Approach Device Qualifier

Y Lower Artery 0 Open 3 Percutaneous 4 Percutaneous Endoscopic

0 Drainage Device 2 Monitoring Device 3 Infusion Device 4 Drug-eluting Intraluminal Device 7 Autologous Tissue Substitute 9 Autologous Venous Tissue A Autologous Arterial Tissue C Extraluminal Device D Intraluminal Device J Synthetic Substitute K Nonautologous Tissue Substitute

Z No Qualifier

Y Lower Artery X External 0 Drainage Device 1 Radioactive Element 2 Monitoring Device 3 Infusion Device 4 Drug-eluting Intraluminal Device D Intraluminal Device

Z No Qualifier

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Coding Example

Bilateral - Myringotomy and tympanostomy tube insertion

Section 0 Medical and Surgical

Body System 9 Ear, Nose, Sinus

Operation 9 Drainage: Taking or letting out fluids and/or gases from a body part

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Table

3 External Auditory Canal, Right 4 External Auditory Canal, Left

0 Open 3 Percutaneous 4 Percutaneous Endoscopic 7 Via Natural or Artificial Opening 8 Via Natural or Artificial Opening Endoscopic X External

0 Drainage Device Z No Qualifier

3 External Auditory Canal, Right 4 External Auditory Canal, Left

0 Open 3 Percutaneous 4 Percutaneous Endoscopic 7 Via Natural or Artificial Opening 8 Via Natural or Artificial Opening Endoscopic X External

Z No Device X Diagnostic Z No Qualifier

5 Middle Ear, Right 6 Middle Ear, Left 9 Auditory Ossicle, Right A Auditory Ossicle, Left D Inner Ear, Right E Inner Ear, Left

0 Open 0 Drainage Device Z No Qualifier

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Answer

099500Z

AND

099600Z

5 is middle ear, right and 6 is middle ear, left

Questions

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