ICD-10-PCS Course (continued)

Lesson 2: ICD-10-PCS Sections     Procedures in the Medical and Surgical Section           Root Operation Groups           Approaches         Procedures in the Medical and Surgical-related Sections           Obstetrics—Section 1           Placement—Section 2           Administration—Section 3           Measurement and Monitoring—Section 4           Extracorporeal Assistance and Performance—Section 5           Extracorporeal Therapies—Section 6           Osteopathic—Section 7           Other Procedures—Section 8           Chiropractic—Section 9                 Procedures in the Ancillary Sections           Imaging—Section B           Nuclear Medicine—Section C           Radiation Therapy—Section D           Physical Rehabilitation and Diagnostic Audiology—Section F           Mental Health—Section G           Substance Abuse Treatment—Section         New Technology–Section X Lesson 3: Coding in ICD-10-PCS         ICD-10-PCS Coding – Key Concepts - Review             Locating a Code in ICD-10-PCS             Step-By-Step ICD-10-PCS Coding Examples     ICD-10-PCS Learning Activity     ICD-10-PCS Practice Questions Link to Post-Test

Lesson 2: ICD-10-PCS Sections

Root operations that take out some or all of a body part - Five root operations representing procedures for taking out or otherwise eradicating some or all of a body part are listed in the table below.

Root operations that take out solids/fluids/gases from a body part - Three root operations representing procedures that take out solids, fluids, or gases from a body part are listed in the table below.

Root operations involving cutting or separation only - Two root operations representing procedures that cut or separate a body part are listed in the table below. 

Root operations that put in/put back or move some/all of a body part - Four root operations representing procedures that put in, put back, or move some or all of a body part are listed in the table below.

Root operations that alter the diameter/route of a tubular body part - Four root operations representing procedures that alter the diameter or route of a tubular body part are listed in table below. 

Root operations that always involve a device - Six root operations representing procedures that always involve a device are listed in the table below. 

Root operations involving examination only - Two root operations representing procedures that involve examination of a body part are listed in the table below. 

Root operations that define other repairs - Two root operations representing procedures that define other repairs are listed in the table below. 

The root operation REPAIR represents a broad range of procedures for restoring the anatomic structure of a body part such as suture of lacerations. REPAIR also functions as the “not elsewhere classified (NEC)” root operation, to be used when the procedure performed does not meet the definition of one of the other root operations. 

Root operations that define other objectives - Three root operations in the Medical and Surgical section, FUSION, ALTERATION, and CREATION, describe procedures performed for three distinct reasons. Beyond that they have little in common. 

A FUSION procedure puts a dysfunctional joint out of service rather than restoring function to the joint. 

ALTERATION encompasses a whole range of procedures that share only the fact that they are done to improve the way the patient looks. 

CREATION represents only two very specific sex change operations. 

The fifth and sixth characters in this section define duration and function respectively. These characters describe the duration of the procedure and the body function being acted upon, rather than the approach and device used. 

The root operations ASSISTANCE and PERFORMANCE are two variations of the same kinds of procedures, varying only in the degree of control exercised over the physiological function. 

The second character contains a single general body system choice, PHYSIOLOGICAL SYSTEMS. The sixth character is defined as a qualifier, but contains no specific qualifier values. The seventh character qualifier identifies various blood components separated out in pheresis procedures. 

The meaning of each root operation is consistent with the term as used in the medical community. DECOMPRESSION and HYPERTHERMIA have a more specialized meaning. All are defined in the table below. 

The sixth-character methods such as LYMPHATIC PUMP and FASCIAL RELEASE are not explicitly defined in ICD-10-PCS, and rely on the standard definitions as used in this specialty. 

There are relatively few procedure codes in this section, for nontraditional, whole body therapies including acupuncture and meditation. There is also a code for the fertilization portion of an in-vitro fertilization procedure. 

Codes in these sections contain characters not previously defined, such as Contrast, Modality Qualifier and Equipment. 

• Third character defines procedure by root type, instead of root operation.

• Fifth character defines contrast if used.

• Sixth character is a qualifier that specifies an image taken without contrast followed by one with contrast.

• Seventh character is a qualifier that is not specified in this section.

The IMAGING root types are defined in the following table: 

• The third character classifies the procedure by root type instead of by root operation.

• The fifth character specifies the radionuclide, the radiation source used in the procedure. Choices are applicable for the root procedure type.

• The sixth and seventh characters are qualifiers, and are not specified in this section.

• Third character defines root type, which is the basic modality.

• Fifth character further specifies treatment modality.

• Sixth character defines the radioactive isotope used, if applicable.

• Seventh character is a qualifier, and is not specified in this section.

The third character defines the treatment modality as root type. Examples are BRACHYTHERAPY and STEREOTACTIC RADIOSURGERY. Four different root types are used in this section, as listed in the table below. 

• Second character is a section qualifier that specifies whether the procedure is a rehabilitation or diagnostic audiology procedure.

• Third character defines the general procedure root type.

• Fourth character defines the body system and body region combined, where applicable.

• Fifth character further specifies the procedure type.

• Sixth character specifies the equipment used, if any.

This section uses the third character to classify procedures into 14 root types. They are defined in the table below. 

• Third character describes the mental health procedure root type.

• Fourth character further specifies the procedure type as needed.

• Second, fifth, sixth, and seventh characters do not convey specific information about the procedure. The value Z functions as a placeholder in these characters.

The third character describes the mental health root type. There are 11 root type values in this section, as listed in the table below. 

• Third character describes the root type.

• Fourth character is a qualifier that further classifies the root type.

• Second, fifth, sixth, and seventh characters do not convey specific information about the procedure. The value Z functions as a placeholder in these characters.

There are seven different root type values classified in this section, as listed in the following table. 

Lesson 3: Coding in ICD-10-PCS

ICD-10-PCS - Key Concepts - Review

The ability of the coder to build the correct ICD-10-PCS code requires a greater knowledge of anatomy and physiology than under ICD-9-CM Volume 3. Furthermore, coders will continue to be dependent on physician documentation included in the operative or procedure reports.

ICD-10-PCS is used for facility reporting of hospital inpatient procedures and does NOT affect the use of CPT. 

• ICD-10-PCS is divided into Tables and an Index

• The ICD-10-PCS Official Guidelines for Coding and Reporting is a set of rules that go with the official conventions and instructions given within ICD-10-PCS

• The ICD-10-PCS system structure is divided into 17 sections that name the general type of procedure or service.

• Each ICD-10-PCS code character is an aspect of the procedure. Specify all 7 characters for a code to be valid.

• The process of building an ICD-10-PCS code consists of assigning values from the valid choices for that part of the system using the rules for building codes.

• ICD-10-PCS Tables give the available value choices to build a complete and valid code.

• The ICD-10-PCS Index is an alphabetic lookup so you can locate the correct Table that has all the information you need to build a procedure code. It gives the first 3 or 4 values of the code and refers to a specific location in the Tables.

• Section X, New Technology, provides a place for codes for certain new technology procedures not currently classified in ICD-10-PCS.

• Proper procedure coding involves using the ICD-10-PCS to choose the correct codes for procedures or services based on documentation in a patient’s medical record and assigning those codes correctly on claims

• The first character of an ICD-10-PCS code specifies the section

• Characters 2-7 mean the same thing within each section, but may mean different things in other sections

• In all sections, the third character specifies the general type of procedure performed

• The purpose of the Index is to locate the correct Table that has all information needed to build a procedure code

• The Index specifies the first 3 or 4 values of the code

• Based on the first 3 values of the code in the Index, you can find the corresponding Table

• Within an ICD-10-PCS Table, codes include all combinations of choices in characters 4-7 included in the same row of the Table

• Common ICD-10 coding errors include: >Coding the diagnosis code and forgetting to code the procedure code >Coding the incorrect procedure code based on insufficient documentation in the medical record

• If more than 1 procedure meets the definition of a principal procedure, list them on the claim and choose the 1 most related to the principal diagnosis as the principal procedure

• With rare exceptions, ICD-10-PCS doesn't define multiple procedures with 1 code

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• Review any subterms under the main term in the Index.

• Follow any cross-reference instructions, such as –see, –see also.

• Verify the code(s) selected from the Index in the Root Operation Tables.

• All ICD-10-PCS codes consist of seven characters.

• See the full text description for an ICD-10-PCS code in the List of Codes.

Example 1: Excision of chalazion from the left upper eyelid.

Example 2: Reattachment of right upper arm.

Example 3: Heart catheterization with cardiac mapping.

Example 4: Arthroscopy with drainage of hemarthrosis at previous operative site, right knee.

Example 5: Laparotomy with drain placement for liver abscess, right lobe.

Example 6: Replantation of avulsed scalp.

Example 7: Removal of packing material from pharynx.

Example 8: External electrocardiogram (EKG), single reading.

Example 9: Ultraviolet light phototherapy, series treatment.

Example 10: X-ray of right clavicle, limited study.

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ICD-10-PCS Basics and Beyond