100 Tips for ICD-10-PCS Coding: Tips 1-10

ICD-10-PCS is a major departure from ICD-9-CM procedure coding, and as such many Coding Specialists find ICD-10-PCS much more challenging to learn than ICD-10-CM (which still shares many similarities with ICD-9-CM).  In order to ease the transition from ICD-9-CM procedure coding to ICD-10-PCS, over the next ten months, we will provide tips for coding under this system.

#1

All ICD-10-PCS codes are seven characters long, unlike in ICD-10-CM codes where many valid codes may contain fewer than seven characters.  Each character in the seven-character code represents an aspect of the procedure (ICD-10-PCS Reference Manual, p. 15).

Example:

Six character code 10E0XZ is invalid, the complete ICD-10-PCS code for a manually assisted delivery is 10E0XZZ (obstetrics, pregnancy, delivery, products of conception, external approach, no device, no qualifier).

#2

The letters “I” and “O” are not used in ICD-10-PCS, to eliminate confusion with the numbers “1” and “0” which are used in the system (ICD-10-PCS Reference Manual, p. 15).

Example:

ICD-10-PCS root operation table “021” should be read as “zero, two, one.”

#3

The External approach is used for all procedures coded using the Change ICD-10-PCS root operation (ICD-10-PCS Reference Manual, p. 111).

External is defined as – 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.

Change is defined as – 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.

#4

The sixth character in ICD-10-PCS classifies a device that is left in place at the end of the procedure.  The devices fall into four basic categories:

• Grafts and prostheses
• Implants
• Simple or mechanical appliances
• Electronic appliances (ICD-10-PCS Reference Manual, p. 18).

Coding Alert:

Do not select a device character for a device that is not left inside of the patient at the end of the procedure.

#5

An ICD-10-PCS root operation table may be separated into rows to specify the valid choices of values in characters 4 through 7.  A code built using values from more than one row of a table is not a valid code (ICD-10-PCS Reference Manual, p. 22).

Example:

0B110D4 is not a valid code in the 0B1 root operation table, because the fourth through sixth values are taken from the first row, while the seventh value “4” is taken from the second row of the table.

Section 0 Medical and surgical Body System B Respiratory System Operation 1 Bypass: Altering the route of passage of the contents of a tubular body part
Body Part	Approach	Device	Qualifier
1 Trachea	0 Open	D Intraluminal Device	6 Esophagus
1 Trachea	0 Open	F Tracheostomy Device Z No Device	4 Cutaneous
1 Trachea	3 Percutaneous   4 Percutaneous Endoscopic	F Tracheostomy Device   Z No Device	4 Cutaneous

#6

There is an Index for the ICD-10-PCS root operation tables.  The index is organized as an alphabetic lookup.  Two types of main terms are listed in the Index:

• Based on the value of the third character
• Common procedure terms (ICD-10-PCS Reference Manual, p. 22).

Index Excerpt:

Pneumonectomy

see Resection, Respiratory System 0BT

see Resection, Respiratory System 0BT

#7

Bone marrow biopsies are not coded to the root operation Excision, they are coded to the root operation Extraction, with the qualifier Diagnostic (ICD-10-PCS Reference Manual, p. 36).

Index Excerpt:

Extraction

Bone Marrow

Iliac 07DR

Sternum 07DQ

Vertebral 07DS

#8

Endometrial biopsies are not coded to the root operation Excision, they are coded to the root operation Extraction, with the qualifier Diagnostic (ICD-10-PCS Reference Manual, p. 36).

Index Excerpt:

Extraction

Endometrium 0UDB

#9

Excisional debridement is coded using the Excision root operation; non-excisional debridement is coded using the Extraction root operation (ICD-10-PCS Index).

Index Excerpt:

Debridement

Excisional see Excision

Non-excisional see Extraction

#10

Although eponyms are not used in the ICD-10-PCS root operation tables, the DeBakey Left Ventricular Assist Device is referenced in the ICD-10-PCS Index.  This device – invented by Dr. Michael E. DeBakey – is intended for use in individuals in end-stage heart failure, either as a bridge to heart transplantation for heart transplant candidates, or as destination therapy for individuals ineligible for heart transplantation (Coding Clinic for ICD-9-CM, Fourth Quarter 2003, American Hospital Association).

Index Excerpt:

DeBakey Left Ventricular Assist Device use Implantable Heart Assist System in Heart and Great Vessels

About the Author

Lolita M. Jones, RHIA, CCS, is the principal of Lolita M. Jones Consulting Services (LMJCS), founded in October 1998in Fort Washington, MD.  Ms. Jones has over 25 years of experience in coding and consulting. She started preparing for the implementation of ICD-10-CM/PCS by going back to school. On Sept. 12, 2010, Ms. Jones became an AHIMA-approved ICD-10-CM/PCS trainer.

Contact the Author

lolitamj@aol.com

To comment on this article please go to editor@icd10monitor.com

Resources

To download the 2013 ICD-10-PCS codes and resources go to

http://www.cms.gov/Medicare/Coding/ICD10/2013-ICD-10-PCS-GEMs.html

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