2012 ICD-10-PCS Coding in ICD-10-PCS coding. a leading health services business. Detailed Instruction for INGENIX LEARNINGINGENIX 2012 Ingenix now OptumInsight, part of Optum— aster the different organizational aster the different principles and classification system Appropriate M INGENIX LEARNING A full suite resources of including the latest code set, mapping products, and expert training to help make you a smooth transition. www.shopingenix.com/ICD10 ICD-10

A full suite of resourcesA full suite of the including latest code set, products, mapping and expert a smooth to transition.training help you make www.optumcoding.com/ICD10

New ICD-10-PCS coding ICD-10-PCS conventions, and guidelines of of guidelines and conventions, An educational guide to the structure, structure, to the guide educational An ICD-10-PCS Coding ICD-10-PCS for Appropriate Appropriate for Detailed Instruction CODING & REIMBURSEMENT EDUCATIONAL SERIES: EDUCATIONAL REIMBURSEMENT & CODING See inside for

sample pages. ICD-10

2012 Detailed Instruction for INGENIX LEARNING Appropriate ICD-10-PCS Coding

A successful transition from ICD-9-CMChapter to the 2: ICD-10-PCS coding system will require focused Introductiontraining for individuals andto organizations ICD-10-PCS alike. Procedure codes are built from a range of variables including root operation, body system, STRUCTURE AND COMPONENTS  OBJECTIVES This chapter will provide an overviewbody of the part, structure approach, of ICD-10-PCS and and more—not how In this selected chapter you will learn: its components make up each code. In addition, the PCS coding conventions from a list. And, in some instances,• multiple The basic structure of each contained in the official ICD-10-PCS Coding Guidelines will be discussed. The ICD-10-PCS code complete set of official guidelines may be found in appendix A at the end of this codes may even be needed. • The general definition of each of book. the seven PCS characters

™ • About the three components of The ICD-10-PCS system is a completelyThe Optum different Detailed type of Instruction coding system for Appropriatethan ICD-10-PCSPCS (Index, Tables, Coding List of Codes) ISBN: 978-1-60151-609-1 many coding professionals may begoes familiar beyond with. the Instead official of guidelineslooking up bycodes anticipating in • Thequestions structure andof the PCS tables Itemthe number: index and ITPE12 verifying a fixed code in the tabular list that most likely matches points of confusion. This resource helps beginningfrom and which advanced codes are constructed Price:the $129.95documentation in medical record, PCS codes are constructed from • How to use the alphabetic index Size:component 8 in x 11 parts in found in tables. codersEvery PCS understand code is made the different up of seven approach to ICD-10-PCSto initiate coding, code construction an Binding:characters, softbound and each character representsessential a distinctskill since value. reimbursements An alphabetic forindex Medicare is inpatient services used to direct the coder to a specificmake PCS up table, a significant where the portion remaining of hospitalcode values revenues. are selected. By utilizing a table format, exponentially more codes may be constructed in PCS than were availableThe Detailed in ICD-9-CM Instruction volume for 3.Appropriate Compared ICD-10-PCSto Coding can Orderthe today.current “look-up” process for ICD-9-CM,help you: coding in ICD-10-PCS requires a process of combining semi-independent• Master values the from very among different a selection organizational of values, principles and completely according to the rules governing the construction of codes. Call new classification system that are the foundation of ICD-10-PCS Characters with this easy-to-follow guide. 800.464.3649, option 1 Each character in PCS can contain• upMap to 34ICD-9-CM character procedure value options. terminology Each value to ICD-10-PCS rootCODING AXIOM represents a specific option for the generaloperation character terminology. definitions. The The umbrella alphabetic procedures in ICD-9-CM characters A–H, J–N, and P–Z, along with numbers 0–9 are used as character Official Guideline A1: ICD-10-PCS map to several alternative root operations, and,codes some are PCScomposed of seven values vin isitany character position. In order to avoid confusion with numbers 0 characters. Each character is an axis and 1, the letters I and O are not utilized.root operations The vast majority may map of PCS backwards codes follow to many commonlyof classification used that specifies www.optumcoding.comthe format below, with a few exceptionsprocedural related toterms slightly in ICD-9-CM. different character This resource helpsinformation you understand about the procedure definitions for some of the ancillary-related types of services. performed. Within a defined code the key factors that will determine your code selection.range, a character specifies the same type of information in that Character Character Character • CharacterTranslate commonlyCharacter usedCharacter ICD-9-CMCharacter procedural terms to ICD-10- axis of classification. 1 2 3 PCS4 root operations5 with6 the exclusive7 Optum Root Operation Section Body Root BodyConversion Part Approach Table. Device Qualifier System Operation • Quickly solve the foremost ICD-10-PCS coding challenges. Expert A code is constructed by choosing a guidancespecific value helps for coders each of select the seven the correct root operation from characters. Based on details about theamong procedure the 31 performed, root operations values for found each in the medical and surgical character specifying the section, bodysection system, as root well operation, as understand body CMSpart, body part and device keys that approach, device, and qualifier are assigned. Because the definition of each EFINITIONS are crucial to appropriate code assignment.  D character is also a function of its physical position in the code, the same letter or • Test your skills with real-life coding scenarios thatIn ICD-10-PCS include boththe term procedure number placed in a different position in the code has a different meaning. Codes refers to the complete specification are constructed using tables that are answersdefined byand their answer first threerationale character that values.explain whyof the the sevencorrect characters answer that form a The tables will be discussed later in isthis the chapter. most appropriate. valid code. • Follow essential steps in the code building process with a distillation of official guidelines.

© 2011 OptumInsight 67 Chapter 2: Introduction to ICD-10-PCS Chapter 2: Introduction to ICD-10-PCS

STRUCTURE AND COMPONENTS  OBJECTIVES This chapter will provide an overview of the structure of ICD-10-PCS and how In this chapter you will learn: STRUCTURE AND COMPONENTS  OBJECTIVES its components make up each code. In addition, the PCS coding conventions • The basic structure of each This chapter will provide an overview of the structure of ICD-10-PCS and how In this chapter you will learn: contained in the official ICD-10-PCS Coding Guidelines will be discussed. The ICD-10-PCS code its components make up each code. In addition, the PCS coding conventions complete set of official guidelines may be found in appendix A at the end of this • The basic structure of each • The general definition of each of contained in the official ICD-10-PCS Coding Guidelines will be discussed. The ICD-10-PCS code book. the seven PCS characters complete set of official guidelines may be found in appendix A at the end of this • The general definition of each of • About the three components of book. the seven PCS characters The ICD-10-PCS system is a completely different type of coding system than PCS (Index, Tables, List of Codes) • About the three components of The ICD-10-PCS system is a completely different type of coding system than many coding professionals may be familiar with. Instead of looking up codes in • The structure of the PCS tables PCS (Index, Tables, List of Codes) Master the manyvery differentcoding professionals may be familiar with. Instead of looking up codes in the index and verifying a fixed code in the tabular list that most likely matches from which codes are constructed • The structure of the PCS tables the index and verifying a fixed code in the tabular list that most likely matches the documentation in medical record, PCS codes are constructed from organizational principles and from which codes are constructed • How to use the alphabetic index the documentation in medical record, PCS codes are constructed from to initiate code construction completely new classification • How to use the alphabetic index component parts found in tables. Every PCS code is made up of seven component parts found in tables. Every PCS code is made up of seven to initiate code construction characters, and each character represents a distinct value. An alphabetic index is system thatcharacters, are the foundation and each character represents a distinct value. An alphabetic index is used to direct the coder to a specific PCS table, where the remaining code values of ICD-10-PCS.used to direct the coder to a specific PCS table, where the remaining code values are selected. By utilizing a table format, exponentially more codes may be are selected. By utilizing a table format, exponentially more codes may be constructed in PCS than were available in ICD-9-CM volume 3. Compared to constructed in PCS than were available in ICD-9-CM volume 3. Compared to the current “look-up” process for ICD-9-CM, coding in ICD-10-PCS requires a the current “look-up” process for ICD-9-CM, coding in ICD-10-PCS requires a process of combining semi-independent values from among a selection of values, process of combining semi-independent values from among a selection of values, according to the rules governing the construction of codes. according to the rules governing the construction of codes.

Characters Characters Distills official guidelines Each character in PCS can contain up to 34 characterinto valueessential options. steps Each in the value CODING AXIOM Each character in PCS can contain up to 34 character value options. Each value ODING XIOM   C A represents a specific option for the general character definitions.code building The process.alphabetic represents a specific option for the general character definitions. The alphabetic characters A–H, J–N, and P–Z, along with numbers 0–9 are used as character Official Guideline A1: ICD-10-PCS characters A–H, J–N, and P–Z, along with numbers 0–9 are used as character Official Guideline A1: ICD-10-PCS codes are composed of seven codes are composed of seven values in any character position. In order to avoid confusion with numbers 0 characters. Each character is an axis values in any character position. In order to avoid confusion with numbers 0 characters. Each character is an axis and 1, the letters I and O are not utilized. The vast majority of PCS codes follow of classification that specifies and 1, the letters I and O are not utilized. The vast majority of PCS codes follow of classification that specifies the format below, with a few exceptions related to slightly different character information about the procedure the format below, with a few exceptions related to slightly different character information about the procedure definitions for some of the ancillary-related types of services. performed. Within a defined code performed. Within a defined code range, a character specifies the definitions for some of the ancillary-related types of services. same type of information in that Character Character Character Character Character Character Character range, a character specifies the axis of classification. same type of information in that 1 2 3 4 5 6 7 Character Character Character Character Character Character Character axis of classification. 1 2 3 4 5 6 7 Section Body Root Body Part Approach Device Qualifier System Operation Section Body Root Body Part Approach Device Qualifier System Operation A code is constructed by choosing a specific value for each of the seven characters. Based on details about the procedure performed, values for each A code is constructed by choosing a specific value for each of the seven character specifying the section, body system, root operation, body part, characters. Based on details about the procedure performed, values for each approach, device, and qualifier are assigned. Because the definition of each  DEFINITIONS character is also a function of its physical position in the code, the same letter or character specifying the section, body system, root operation, body part, In ICD-10-PCS the term procedure approach, device, and qualifier are assigned. Because the definition of each  DEFINITIONS number placed in a different position in the code has a different meaning. Codes refers to the complete specification character is also a function of its physical position in the code, the same letter or are constructed using tables that are defined by their first three character values. of the seven characters that form a In ICD-10-PCS the term procedure The tables will be discussed later in this chapter. valid code. number placed in a different position in the code has a different meaning. Codes refers to the complete specification are constructed using tables that are defined by their first three character values. of the seven characters that form a The tables will be discussed later in this chapter. valid code. Sample page from the new Detailed Instruction for Appropriate ICD-10-PCS Coding. Call 800.464.3649, option 1 or visit www.optumcoding.com to order. © 2011 OptumInsight 67

© 2011 OptumInsight 67 OptumInsight Learning: Detailed Instruction for Appropriate ICD-10-PCS Coding 3: Upper Operation–Character 3 Body Part–Character 4 Approach–Character 5 Device–Character 6 Qualifier–Character 7 1 Bypass 0 Internal Mammary , 0 Open 0 Drainage Device 0 Upper Artery, Right Right 5 Destruction 1 Internal Mammary Artery, 3 Percutaneous 2 Monitoring Device 1 Upper Arm Artery, Left Left 7 Dilation 2 Innominate Artery 4 Percutaneous 3 Infusion Device 2 Upper Arm Artery, Endoscopic Bilateral 9 Drainage 3 , Right X External 4 Intraluminal Device, 3 Lower Arm Artery, Right Drug-eluting B Excision 4 Subclavian Artery, Left 7 Autologous Tissue 4 Lower Arm Artery, Left Substitute C Extirpation 5 , Right 9 Autologous Venous 5 Lower Arm Artery, Tissue Bilateral H Insertion 6 Axillary Artery, Left A Autologous Arterial 6 Upper Leg Artery, Right Character meaning tables Tissue J Inspection 7 Brachialprovide Artery, Right every valid character B Intraluminal Device, 7 Upper Leg Artery, Left Bioactive L Occlusion 8 Brachialvalue Artery, forLeft each of the 31 PCS C Extraluminal Device 8 Upper Leg Artery, Bilateral N Release 9 ,body Right systems. D Intraluminal Device 9 Lower Leg Artery, Right P Removal A Ulnar Artery, Left J Synthetic Substitute B Lower Leg Artery, Left Q Repair B , Right K Nonautologous Tissue C Lower Leg Artery, Bilateral Substitute R Replacement C Radial Artery, Left M Stimulator Lead D Upper Arm S Reposition D Hand Artery, Right Z No Device F Lower Arm Vein U Supplement F Hand Artery, Left G Intracranial Artery V Restriction G Intracranial Artery J Extracranial Artery, Right W Revision H , K Extracranial Artery, Left Right J Common Carotid Artery, Left M Pulmonary Artery, Right K , Right N Pulmonary Artery, Left L Internal Carotid Artery, Left X Diagnostic M , Z No Qualifier Right Map of Upper Arteries N External Carotid Artery, Left

P , Right Temporal S, T Q Vertebral Artery, Left Internal carotid K, L Facial R R Face Artery External carotid M, N Right and left common Vertebral P, Q S Temporal Artery, Right carotid H, J U, V T Temporal Artery, Left Brachiocephalic 2 Internal mammary 0, 1 U Artery, Right Subclavian 3,4 Subclavian 3, 4 Pulmonary V Thyroid Artery, Left Axillary 5, 6 Aorta IllustrationsY Upper demonstrate Artery Brachial 7, 8 mapping of specific body parts to appropriate ICD-10-PCS character values.

Radial B, C

Ulnar 9, A Sample page from the new Detailed Instruction for Appropriate ICD-10-PCS Coding. Call 800.464.3649, option 1 or visit www.optumcoding.com to order. 108 © 2012 OptumInsight, Inc. Chapter 6: Medical and Surgical Character Meanings and Illustrations by Body System

Body Part Key Definitions (Character 4) PCS Body Part Associated Terms Value Internal Mammary Artery, Left Anterior intercostal artery, Internal thoracic artery, Musculophrenic artery, Pericardiophrenic 0, 1 & Right artery, Superior epigastric artery Innominate Artery Brachiocephalic artery, Brachiocephalic trunk 2 Subclavian Artery, Left & Right , Dorsal scapular artery, Internal thoracic artery 3, 4 SpecificAxillary body Artery, part Leftkey & Right Anterior circumflex humeral artery, , Posterior circumflex humeral 5, 6 entries are assembled artery, , , , Left & Right Inferior ulnar collateral artery, Profunda brachii, Superior ulnar collateral artery 7, 8 for eachUlnar body Artery, system, Left & Right Anterior ulnar recurrent artery, Common interosseous artery, Posterior ulnar recurrent artery, 9, A providingRadial detail Artery, of Left specific & Right Radial recurrent artery B, C body partsHand and Artery, their Left & Right Deep palmar arch, Princeps pollicis artery, Radialis indicis, D, F correspondingIntracranial characters. Artery Anterior cerebral artery, Anterior choroidal artery, Anterior communicating artery, Basilar G artery, Circle of Willis, , Posterior cerebral artery, Posterior communicating artery, Posterior inferior (PICA) Internal Carotid Artery, Left & Caroticotympanic artery, Carotid sinus, K, L Right External Carotid Artery Ascending pharyngeal artery, Internal , , Maxillary artery, M, N , Posterior auricular artery, Vertebral Artery, Left & Right , P, Q Face Artery , Ascending palatine artery, External maxillary artery, , Inferior R labial artery, , Temporal Artery, Left & Right , Superficial temporal artery, Transverse facial artery S, T Thyroid Artery Cricothyroid artery, Hyoid artery, Sternocleidomastoid artery, Superior laryngeal artery, U, V Superior thyroid artery, Thyrocervical trunk

Cerebrovascular Arteries Posterior parietal G Callosal-marginal G Parietal- Pericallosal occipital G G Anterior cerebral G Calcarine G Anterior Some Illustrations provide Posterior communicating G detail for all body parts cerebral G Middle cerebral G assigned to the same PCS Ophthalmic K, L Anterior body part character. inferior Posterior cerebellar G communicating G External Posterior carotid inferior M, N cerebellar G Internal Circle of Willis carotid K, L Basilar G Circle of Anterior Willis G communicating artery G External Carotid Artery (M, N)

Internal Posterior carotid K, L Auricular Internal M, N carotid K, L Maxillary M, N Posterior Occipital Basilar G M, N artery G

Lingual M, N Vertebral arteries P, Q Sample page from the new Detailed Instruction for Ascending Superior Appropriate ICD-10-PCS Coding. Call 800.464.3649, Pharyngeal M, N thyroid M, N option 1 or visit www.optumcoding.com to order. © 2012 OptumInsight, Inc. 109 OptumInsight Learning: Detailed Instruction for Appropriate ICD-10-PCS Coding

DEFINITIONS

Approach Definitions Access Visualization/ Location Access Method Instrumentation Approach Definition Example Skin or mucous Cutting through None Open Cutting through the skin or mucous Abdominal membrane body layers (0) membrane and any other body layers hysterectomy necessary to expose the site of the procedure Open CABG At-a-glance definition and Open endarterectomy explanation of each approach, With visualization Open Cutting through the skin or mucous Laparoscopic-assisted (0) membrane and any other body layers sigmoidectomy with examples of each. necessary to expose 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 Puncture or small None Percutaneous Entry, by puncture or minor incision, of Needle biopsy of liver incision (3) instrumentation through the skin or mucous Liposuction membrane and/or any other body layers necessary to reach the site of the procedure With visualization Percutaneous Entry, by puncture or minor incision, of Arthroscopy Endoscopic instrumentation through the skin or mucous Laparoscopic (4) membrane and/or any other body layers cholecystectomy necessary to reach and visualize the site of Endoscopic drainage of the procedure sinuses None None External Procedures performed directly on the skin Closed fracture (X) or mucous membrane and procedures reduction performed indirectly by the application of Resection of tonsils external force through the skin or mucous Excision of lesion membrane Cautery of nose bleed Puncture or small With visualization Via Natural or Artificial Entry of instrumentation through a natural or Endoscopicaly assisted incision. With Opening with artificial external opening to reach and PEG tube placement instrumentation Percutaneous visualize the site of the procedure, and Laparoscopic-assisted assistance Endoscopic Assistance entry, by puncture or minor incision, of vaginal hysterectomy (F) instrumentation through the skin or (LAVH) mucous membrane and any other body layers necessary to aid in the performance of the procedure Orifice Natural or artificial None Via Natural or Artificial Entry of instrumentation through a natural or Foley catheter external opening Opening artificial external opening to reach the site of placement (7) the procedure Digital rectal exam Endotracheal intubation With visualization Via Natural or Artificial Entry of instrumentation through a natural or Sigmoidoscopy Opening Endoscopic artificial external opening to reach and EGD (8) visualize the site of the procedure Colonscopy

DEVICE DEFINITIONS Note: Do not assign a device value unless the device remains in the patient at the conclusion of the procedure.

Grafts and Prostheses Biological or synthetic material that takes the place • Autologous tissue substitute • Nonautologous tissue of all or a portion of a body part. • Joint prostheses substitute • Zooplastic tissue Implants Therapeutic material that is not absorbed by, • Orthopedic pins • Radioactive element implant eliminated by, or incorporated into a body part. Therapeutic materials that are considered devices can be removed. Essential definitions Simple or Mechanical Biological or synthetic material that assists or • Drainage device • Intraluminal deviceof each type of device Appliances prevents a physiological function. • Extraluminal device • Tracheostomy device found in PCS. • Endobrachial device • IUD Electronic Appliances Electronic appliances used to assist, monitor, take • Cardiac leads • Hearing device the place of, or prevent a physiological function. • Diaphragmatic pacemaker • Monitoring device • External heart assist system • Neurostimulator

Sample page from the new Detailed Instruction for Appropriate ICD-10-PCS Coding. Call 800.464.3649, option 1 or visit www.optumcoding.com to order. 82 © 20112012 OptumInsight Appendix: Root Operation Conversion Table

ROOT OPERATION CONVERSION TABLE Documented Procedure PCS Root Operation Key Objective of Procedure/Comment Common Suffixes -centesis Drainage 9 -desis Fusion G -ectomy Excision B Cutting out or off, without replacement, a portion Resection T Cutting out or off, without replacement, all of a body part -exeresis Extraction D -lysis Release N -oscopy Inspection J -otomy Division 8 Cutting into body part w/o taking out fluids and/or gases to separate or transect a Provides potential PCS root body part operation and characters for Drainage 9 Taking out fluids and/or gases -pexy Repair Q Restoring to normal anatomy or function—Used only when no other root common suffixes found in operation is applicable procedural documentation. Reposition S Move body part to a new location (e.g., free flaps) -plasty Repair Q Restoring to normal anatomy or function—Used only when no other root operation is applicable ReplacementDVC R Putting in/on biological/synthetic material to take the place and/or function of a body part SupplementDVC U Putting in/on biologic/synthetic material to reinforce and/or augment the function of a body part. -plication Restriction V -rraphy Repair Q -stasis Control 3 -tripsy Fragmentation F Common Procedures Adenoidectomy partial Excision B Coded separately from concomitant tonsillectomy total Resection T Coded separately from concomitant tonsillectomy Adhesiolysis Release N Advancement (flap) Reposition S Move body part to a new location (e.g., free flaps) Transfer X Move body part to another location to take over the function, still connected to its vascular and nervous supply Amniocentesis Drainage 9 See table 1Ø9 Amputation (extremity) Detachment 6 Anastomosis Bypass 1 Aneurysm clipping Restriction V Angiocardiography (e.g., with cardiac Plain Radiography Ø See table B2Ø cath) Angioplasty Dilation 7 Expanding orifice or lumen (e.g., PTCA) Repair Q Restoring to normal anatomy or function—Used only when no other root operation is applicable ReplacementDVC R Putting in/on biological/synthetic material to take the place and/or function of a body part SupplementDVC U Putting in/on biologic/synthetic material to reinforce and/or augment the function of a body part Exclusive OptumInsight Root Annuloplasty with ring Supplement DVC U Operation Conversion table Antrostomy Drainage 9 Arthrocentesis Drainage 9 translates commonly used ICD-9 Arthroplasty Repair Q Restoring to normal anatomy or function—Usedprocedural only when no termsother root to ICD-10-PCS operation is applicable ReplacementDVC R Putting in/on biological/synthetic material to take the place and/or functionroot of operations. a body part SupplementDVC U Putting in/on biologic/synthetic material to reinforce and/or augment the function of a body part Arthroscopy Inspection J Aspiration Drainage 9 Banding Restriction V Sample page from the new Detailed Instruction for Appropriate ICD-10-PCS Coding. Call 800.464.3649, option 1 or visit www.optumcoding.com to order. 2012 OptumInsight © 20122011 OptumInsight 81 NEW See inside for sample pages of this new product

Order your copy of the Detailed Instruction for Appropriate ICD-10-PCS Coding today and save.

Call: 800.464.3649, option 1 Visit: www.optumcoding.com

13625 Technology Drive, Eden Prairie, MN 55344 www.optum.com

Optum and its respective marks are trademarks of Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners. Because we are continuously improving our products and services, Optum reserves the right to change specifications without prior notice. Optum is an equal opportunity employer. 12-27914 12020117 02/12 © 2012 Optum. All Rights Reserved.

Ingenix now OptumInsight, part of Optum— a leading health services business.