ICD-10-Procedure Classification System (PCS) “Have No Fear, ICD10 Is Here” March 5, 2014

Patricia Gowan, RHIA, CPC AHIMA Approved ICD-10-CM/PCS Trainer Background • CMS awarded a contract to 3M to develop a new procedure coding system. • Replaces ICD-9-CM Volume 3 for inpatient procedures • Not used in outpatient/office setting • Continue to use CPT & HCPCS (Healthcare Common Procedure Coding System) codes • ICD-10-PCS located on the CMS website • https://www.cms.gov/Medicare/Coding/ICD10/2014-ICD- 10-PCS.html

ICD-9-CM (Vol. 3) and ICD-10-PCS Characteristic ICD-9-CM ICD-10-PCS

Character Type Numeric codes Alphanumeric codes

Code Length 4 digit max 7 character max Number of Codes 4000+ codes 71,920 codes (2013) Code Structure Decimal • Letters O & I not used; No decimal • 16 Sections • Expandable ICD-10-PCS Attributes • Completeness • Different procedures have a unique code • Expandability • The structure allows incorporation of new procedures as unique codes ICD-10-PCS Attributes • Standardized terminology: • Includes definitions of the terminology used. • There are no eponyms in PCS. • Multiaxial: • The system has a multi-axial structure. • Each character has the same meaning within a section and across sections to the extent possible. Sixteen (16) Sections • Medical and Surgical • Obstetrics • Placement • Administration • Measurement and Monitoring • Extracorporeal Assistance and Performance • Extracorporeal Therapies • Osteopathic

Sixteen (16) Sections • Other Procedures • Chiropractic • Imaging • Nuclear Medicine • Radiation Oncology/Therapy • Physical Rehabilitation and Diagnostic Audiology • Mental Health • Substance Abuse Treatment

ICD-10-PCS Coding Guidelines Conventions • Codes are composed of seven components. Each component is called a “character.” • All seven characters are required for a valid code. • Individual units for each character are represented by a letter or number. • Each unit is called a “value”. • 34 possible values for each character • Numbers 0-9 • Alphabet A-H, J-N, P-Z • “And,” when used in a code description, means “and/or.” Example: Lower Arm and Wrist Muscle means lower arm and/or wrist muscle. Conventions • Use the alpha index to locate the appropriate table to construct a procedure code. • The PCS tables should always be consulted to find the most appropriate valid code. • It is not required to consult the Index first before proceeding to the tables to complete the code. A valid code may be chosen directly from the tables. Conventions • Many tables have multiple rows. • A valid code is comprised of any combination of characters contained in the same row. Selecting characters from different rows creates an invalid code. • 0JHT3VZ valid • 0JHW3VZ invalid Example: ICD-10-PCS Code 0JHT3VZ • Section: 0 Medical and Surgical • Body System: J Subcutaneous Tissue and Fascia • Operation: H 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.

Body Part Approach Device Qualifier Character 4 Character 5 Character 6 Character 7 S Subcutaneous Tissue and Fascia, O Open 1 Radioactive Element Z No Qualifier Head and Neck 3 Percutaneous 3 Infusion Device V Subcutaneous Tissue and Fascia, Upper Extremity W Subcutaneous Tissue and Fascia, Lower Extremity T Subcutaneous Tissue and Fascia, O Open 1 Radioactive Element Z No Qualifier Trunk 3 Percutaneous 3 Infusion Device V Infusion Pump Documentation Expectations ICD-10-PCS Coding Guidelines, A11 • It is the coder’s responsibility to determine what the documentation in the medical record equates to in the PCS definitions. • The physician is not expected to use the terms used in PCS code descriptions. • Nor is the coder required to query the physician when the correlation between the documentation and the defined PCS term is clear: • Example: When the physician documents “partial resection” the coder can independently correlate “partial resection” to the root operation Excision without querying the physician for clarification.

Source: 2011 ICD-10 Coding Guidelines General Principles • Not Otherwise Specified (NOS) options are restricted. • A general body part, approach, or root operation can be used when the level of specificity is not available in the record or cannot be obtained. Example: “Liver” is used when the specific liver lobe is not identified. • A ‘Not Elsewhere Classified’ (NEC) is allowed for new devices (e.g., Other Device) and substances. Medical and Surgical Section Seven Characters

Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body Root Body Part Approach Device Qualifier System Operation Character Meanings • The medical and surgical section codes represent the majority of procedures reported in an inpatient setting. • Medical and surgical procedure codes have a first character value of “0”. • The second character indicates the general body system (e.g., gastrointestinal). Character Meanings Root Operation (Character 3) • Thirty-one root operations in the Medical and Surgical section. • Identifies the objective of the procedure. • Each root operation has a precise definition. For example: • Excision: Cutting out or off, without replacement, a portion of a body part. • Divided into nine groups. Root Operation Groups • Procedures that take out or eliminate all or a portion of a body part • Procedures that involve putting in or on, putting back, or moving body parts • Procedures that take out or eliminate solid matter, fluids, or gases from a body part • Procedures that only involve examination of body parts and regions • Procedures that can be performed only on tubular body parts • Procedures that always involve devices • Procedures involving cutting or separation only • Procedures involving other repairs • Procedures with other objectives

Body Part (Character 4) • Defines the specific anatomical site where the procedure is performed, e.g., duodenum. • Tubular body parts are defined as those hollow body parts that provide a route of passage for solids, liquids, or gases. • Includes the cardiovascular system and body parts contained in the GI tract, GU tract, biliary tract, and 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. (General Guideline B4.1a) • Example: A procedure performed on the alveolar process of the mandible is coded to the mandible body part.

Approach (Character 5) • Defines the technique used to reach the site of the procedure • Seven different approaches: • Open • Percutaneous • Percutaneous Endoscopic • Via Natural or Artificial Opening • Via Natural or Artificial Opening Endoscopic • Via Natural or Artificial with Percutaneous Endoscopic Assistance • External Approaches through the Skin or Mucous Membrane • Open • Percutaneous • Percutaneous Endoscopic Approach Definitions: Open • Cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure. • Example: Abdominal hysterectomy

Approach Definitions: 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. • Example: Needle Biopsy of Liver

Approach Definitions: 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. • Example: Arthroscopy, laparoscopic cholecystectomy

Approach Definitions: Approaches Through an Orifice • Via Natural or Artificial Opening • Via Natural or Artificial Opening Endoscopic • Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance

Approach Definitions Via Natural or Artificial Opening • Entry of instrumentation through a natural or artificial external opening to reach the site of the procedure. • Example: Endotracheal tube insertion

Approach Definitions: 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. • Example: Sigmoidoscopy, EGD

Approach Definitions: Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance • Entry of instrumentation through a natural or artificial external opening 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. • Example: Laparoscopic-assisted vaginal hysterectomy (LAVH) Approach Definition: 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. • Example: Closed fracture reduction, Resection of tonsils Device (Character 6): General Guidelines • B6.1a. A device is coded only if a device remains after the procedure is completed. If no device remains, the device value No Device is coded. • B6.1b. Materials incidental to the procedure such as sutures, ligatures, radiological markers and temporary post-operative wound drains are not coded as devices. Types of Devices (4) • Biological or synthetic material that takes the place of all or a portion of a body part (e.g., skin graft, joint prosthesis). • Biological or synthetic material that assists or prevents a physiological function (e.g., IUD). • Therapeutic material that is not absorbed by, eliminated by, or incorporated into a body part (e.g., radioactive implant). • Mechanical or electronic appliances used to assist, monitor, take the place of or prevent a physiological function (e.g., cardiac pacemaker, orthopedic pin). Qualifier (Character 7) • Contains unique values for individual procedures. • For example, the qualifier can be used to identify the destination site in a Bypass. Resources & References • Official 2014 ICD-10-PCS Coding Guidelines • https://www.cms.gov/Medicare/Coding/ICD10/Downloads/PCS-2014- guidelines.pdf • 2014 Code Tables and Index https://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-PCS.html • Development of the ICD-10 Procedure Coding System • https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2014-pcs- procedure-coding-system.pdf • ICD-10-PCS Reference Manual ICD-10-PCS 2014 • https://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-PCS.html • The Complete Official Draft Code Set, Optum 2013 Questions/Discussion

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