Jennifer McElroy, CPC AHIMA Approved ICD-10 CM/PCS Trainer ICD-10 PCS Coding 101 Jennifer McElroy, CPC AHIMA Approved ICD-10 CM/PCS Trainer

Agenda ICD -10 PCS Guidelines & Conventions Medical Surgical Body Part vs Body System Root Operations Approaches Device Qualifiers Case Studies The Gray Section

ICD-10-PCS Overview Conventions & Guidelines ICD-10-PCS Codes are 7 characters The letters I and O are excluded Built in room for growth Alpha index Characters 1 - 3 Characters 4 – 7

ICD-10-PCS VS Body Part Vs. Body System Mouth & Throat Frenulum linguae

ICD-10-PCS VS Body Part Vs. Body System Aortic Arch Heart and Great Vessels

ICD-10-PCS Body Part Vs. Body System VS Gastrointestinal Sigmoid Colon

ICD-10-PCS Medical Surgical Root Operations Medical and Surgical Section Root Operations 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  

ICD-10-PCS Medical Surgical Root operations Extraction (D)

ICD-10-PCS Medical Surgical Root operations Detachment (6)

ICD-10-PCS Medical Surgical Root operations Transfer (X)

ICD-10-PCS Medical Surgical Root operations Alteration (0)

ICD-10-PCS Medical Surgical Approaches Open (0) Percutaneous (3) Percutaneous Endoscopic (4) Via Natural or Artificial Opening (7) Via Natural or Artificial Opening Endoscopic (8) Via Natural or Artificial Opening with Percutaneous Endoscopic Assist (F) External (X)

ICD-10-PCS Medical Surgical Approaches Via Natural or Artificial Opening (7)

ICD-10-PCS Medical Surgical Approaches Via Natural or Artificial opening with percutaneous Endoscopic Assistance (F)

ICD-10-PCS Medical Surgical Approaches Percutaneous (3)

ICD-10-PCS Medical Surgical Approaches External (X)

ICD-10-PCS Medical Surgical Approaches Open (0)

ICD-10-PCS Medical Surgical Approaches Percutaneous Endoscopic (4)

ICD-10-PCS Medical Surgical Approaches Via Natural or artificial opening endoscopic

ICD -10 PCS Medical surgical Devices Biological or synthetic material that takes the place of all or a portion of a body part (e.g. skin graft) Biological or synthetic material that assists or prevents a physiological function (e.g. urinary catheter, IUD) Therapeutic material that is not absorbed by, eliminated by, or incorporated into a body part (e.g. radioactive implant) Therapeutic materials that are considered devices can be removed. Mechanical or electronic appliances used to assist, monitor, take the place of, or prevent a physiological function (e.g. diaphragmatic pacemaker, orthopedic pins)

ICD -10 PCS Medical surgical Qualifier Allogeneic (0) Syngeneic (1) Zooplastic (2) Diagnostic (X)

ICD-10-PCS Case studies 3.9 Procedure Performed: Subtotal gastrectomy with Billroth II anastomosis 0DB60ZZ Excision, Stomach Gastrectomy, Partial 0D160ZA – Bypass, Stomach 0DHA0UZ – Insertion of device in, jejunum

ICD-10-PCS Case studies 3.13 Procedure Performed: Left initial inguinal hernia repair with mesh 0YU60JZ – Supplement, inguinal region left, herniorrhaphy with sythetic substitute

ICD-10-PCS Case studies 3.38 Procedure Performed: Exploratory laparotomy, sigmoid colectomy, extended right hemicolectomy, colostomy. CODE ONLY PCS codes 0DTN0ZZ – Resection, Colon, Sigmoid 0DTF0ZZ – Resection, Intestine, Large Right Hemicolectomy 0DBL0ZZ – Excision, Colon, Transverse 0D1M0Z4 – Bypass, Colon Descending Colostomy

ICD-10-PCS - Obstetrics Root Operations (2 added) Abortion (A) Delivery (E) Body Parts Products of Conception Products of Conception, retained Products of Conception, ectopic

ICD-10 PCS - Placement Root Operations Compression (1) Dressing (2) Immobilization (3) Packing (4) Traction(6)

ICD-10 PCS - Administration Body Systems Circulatory system Indwelling Device Physiological Systems and Anatomical Regions Root operations Introduction Irrigation Transfusion

Icd-10 PCS – Measurement & Monitoring Measurement – Determining the level of a physiological or physical function at a point in time. Monitoring – Determining the level of physiological or physical function repetitively over a period of time.

ICD-10 PCS – Extracorpeal Extracorpeal Assistance and Performance Root Operations Assistance Performance Restoration

ICD-10 PCS – Extracorpeal Extracorpeal Therapies Root Operations Atmospheric Control Decompression Electromagnetic Therapy Hyperthermia Hypothermia Pheresis Ultrsound Therapy Ultraviolet Light Therapy Shock wave Therapy

ICD-10 PCS Osteopathic, other & Chiropractic Osteopathic Section Root Operation – Treatment Other Procedures Section Root Operation – Other procedures Chiropractic Root Operation - Manipulation Osteopathic Other Procedures Chiropractic – Approach is always external……

Icd-10 Ancillary section Imaging (B) Nuclear Medicine (C) Radiation Oncology (D) Physical Rehabilitation and Diagnostic Audiology (F) Mental Health (G) Substance Abuse Treatment (H) We are at the end finally! Imaging – Chest xrays AP/PA and lateral views Nuclear Med – PET Scans Radiation Oncology – Electron radiation Physical Rehab and Diagnostic Audiology – Wound care treatment, Brace fittings Mental Health – Crisis interventions, psychotherapy Substance Abuse – Drug Addiction, Just like it sounds

ICD-10-PCS Case studies 3.41 Procedure Performed: Transvaginal abortion using vacuum aspiration technique. 10A07Z6 – Abortion, Vacuum If you have your book turn to page 194. I will give you a couple mins to read and answer the case.

ICD-10-PCS Case studies 3.43 Procedure Performed: Fetal spinal tap, percutaneous 10903ZA – Drainage, Products of Conception, Fetal cerebrospinal fluid

ICD-10-PCS Case studies 3.79 Procedure Performed: Alcohol detoxification treatment HZ2ZZZZ – Dextoxification Services for substance abuse

REferences ICD-10-PCS Coder Training Manual, 2013 Edition (AHIMA Press) ICD-10-PCS Official Guidelines for Coding and Reporting