1. Title: ICD-10-PCS General Guidelines Session: T-5-1100
Track x – xxx day –
Title: ICD-10-PCS General Guidelines Session: T

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. Standardized terminology
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
Standardized terminology…we’ll go over the ICD-10 definitions of the root operations in a few slides

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. Example of Code Structure Characters:1 2 3 4 5 6 7
Section
Body System
Root Operation
Body Part
Approach
Device
Qualifier

9. 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 and
Diagnostic Audiology = F
Mental Health = G
Substance Abuse Treatment = H
The first character can be alpha-numeric values as shown. The Medical and Surgical section is the largest of 16 sections

10. 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
There are 31 “body systems” to choose from. The body system values applies primarily but not exclusively, to the Medical and Surgical Section…if you have a different procedure section, such as “F” for physical rehabilitation and diagnostic audiology, the character 0 (zero) is equal to “rehabilitation.” Each section will either have a single or multiple definitions for the second character in each section referred to. The definitions will be consistent in each section.

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
Root operation definitions are applicable to the Medical/Surgical section. In other sections, the third character value will vary. For instance, in “Imaging”, the third character describes the type of imaging, e.g., MRI, CT, plain radiography

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
Percutaneous transluminal 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
Track x – xxx day –
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)
Body Part (4)
Approach (5)
Device (6)
Qualifier (7)
0 Inferior Vena Cava
0 Open
4 Percutaneous Endoscopic
7 Autologous Tissue Substitute
9 Autologous Venous Tissue
A Autologous Arterial Tissue
J Synthetic Substitute
K Nonautologous Tissue Substitute
Z No Device
5 Superior Mesenteric Vein
6 Inferior Mesenteric Vein
Y Lower Vein
First character Zero is always the Medical and Surgical section, second character is Body System, third character Root Operation

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)
Body Part (4)
Approach (5)
Device (6)
Qualifier (7)
Long list…
C Humeral Head, Right
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
5 External Fixation Device
3 Monoplanar
4 Ring
5 Hybrid
9 Limb Lengthening Device
Z No Qualifier
First character Zero is always the Medical and Surgical section, second character is Body System, third character Root Operation

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 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
Fasciotomy
see Division, Subcutaneous Tissue and Fascia
0J8
see Drainage, Subcutaneous Tissue and Fascia
0J9

34. 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
We’ve seen a couple of examples of the code tables without the entire layout…next couple of slides show entire layout

35. Code Table Example Section 0 Medical and Surgical
Body System 4 Lower Arteries
Operation 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
The italicized section, body system and operation are for example only and are not in the tables area of I-10
Each table contains only those combinations of values that will make up a valid procedure code. Remember no diagnostic statements are in the procedure code itself so the parenthesis has the diagnostic medical necessity.
04JY4ZZ = Explore Right Peroneal Artery

36. Code Table Example Section 0 Medical and Surgical
Body 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
X External
1 Radioactive Element
If the lower portion of a table is split, the values of characters must be selected from within the same row

37. Bilateral - Myringotomy and tympanostomy tube insertion
Coding Example
Bilateral - Myringotomy and tympanostomy tube insertion
Section 0 Medical and Surgical
Body System 9 Ear, Nose, Sinus
Operation Drainage: Taking or letting out fluids and/or gases from a body part
Myringotomy and tympanostomy tube insertion are parts of the same operation.

38. 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
Z No Device
X Diagnostic
5 Middle Ear, Right
6 Middle Ear, Left
9 Auditory Ossicle, Right
A Auditory Ossicle, Left
D Inner Ear, Right
E Inner Ear, Left
This is only a partial table for 099…there are actually ten rows of “body parts” to choose from.

39. 099500Z AND 099600Z 5 is middle ear, right and 6 is middle ear, left
Answer
099500Z AND Z 5 is middle ear, right and 6 is middle ear, left
We had to assign two procedure codes since this was a bilateral procedure

40. Questions