Title: ICD-10-PCS General Guidelines Session : T-5-1100

1. Title: ICD-10-PCS General GuidelinesSession: T-5-1100

2. Objectives History of ICD-10-PCS Code Structure Conventions General Guidelines

3. 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

4. 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

5. 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

6. 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

7. 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

8. Code Structure Example of Code Structure Characters:

9. Procedure – First Character

10. Body Systems – Second Character

11. 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

12. 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

13. 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 • Percutaneoustransluminal angioplasty

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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)

30. 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)

31. Qualifier – Seventh Character • Specific orthopedic terms: • Insertion of External Fixation Device, “9” = Limb Lengthening Device • 0PHC359 (0-M&S, P-Upper Bones, H-Insertion)

32. 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])

33. Index

34. 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

35. Code Table Example 04JY4ZZ = Explore Right Peroneal Artery

36. Code Table Example

37. 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

38. Table

39. Answer 099500Z AND 099600Z 5 is middle ear, right and 6 is middle ear, left

40. Questions