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2010 UBO/UBU Conference Title: ICD-10-PCS General Guidelines Session: T-5-1100.

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Presentation on theme: "2010 UBO/UBU Conference Title: ICD-10-PCS General Guidelines Session: T-5-1100."— Presentation transcript:

1 2010 UBO/UBU Conference Title: ICD-10-PCS General Guidelines Session: T

2 Objectives History of ICD-10-PCS Code Structure Conventions General Guidelines 2

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 3

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 4

5 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 5

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 6

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 7

8 Code Structure Example of Code Structure Characters: 8 SectionBody System Root Operation Body Part ApproachDeviceQualifier

9 Procedure – First Character 9 Medical and Surgical = 0Obstetrics = 1 Placement = 2Administration = 3 Measuring and Monitoring = 4Extracorporeal Assistance and Performance = 5 Extracorporeal Therapies = 6Osteopathic = 7 Other Procedures = 8Chiropractic = 9 Imaging = BNuclear Medicine = C Radiation Oncology = DPhysical Rehabilitation and Diagnostic Audiology = F Mental Health = GSubstance Abuse Treatment = H

10 Body Systems – Second Character Central Nervous System = 0Peripheral Nervous System = 1 Heart and Great Vessels = 2Upper Arteries = 3 Lower Arteries = 4Upper Veins = 5 Lower Veins = 6Lymphatic and Hemic Systems = 7 Eye = 8Ear, Nose, Sinus = 9 Respiratory System = BMouth and Throat = C Gastrointestinal System = DHepatobiliary System and Pancreas = F Endocrine System = GSkin and Breast = H Subcutaneous Tissue and Fascia = JMuscles = K Tendons = LBursae and Ligaments = M Head and Facial Bones = NUpper Bones = P Lower Bones = QUpper Joints = R Lower Joints = SUrinary System = T Female Reproductive System = UMale Reproductive System = V Anatomical Regions, General = WAnatomical Regions, Upper Extremities = X Anatomical Regions, Lower Extremities = Y 10

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 11

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 12

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 13

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 14

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 15

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 16

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 17

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 18

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 19

20 Definitions of Root Operations – Third Character 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 20

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 21

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 22

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 23

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 24

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 25

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 26

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 27

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 28

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) 29

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) 30 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

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) 31 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

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]) 32

33 Index Fasciaplasty, fascioplasty see Repair, Subcutaneous Tissue and Fascia0JQ see Replacement, Subcutaneous Tissue and Fascia0JR Fasciectomy see Excision, Subcutaneous Tissue and Fascia 0JB Fasciorrhaphy see Repair, Subcutaneous Tissue and Fascia 0JQ Fasciotomy see Division, Subcutaneous Tissue and Fascia0J8 see Drainage, Subcutaneous Tissue and Fascia0J9 33

34 Code Tables 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 34

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 35 Body PartApproachDeviceQualifier Y Lower Artery0 Open 3 Percutaneous 4 Percutaneous Endoscopic X External Z No DeviceZ No Qualifier 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 36 Body PartApproachDeviceQualifier Y Lower Artery0 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 Y Lower ArteryX External0 Drainage Device 1 Radioactive Element 2 Monitoring Device 3 Infusion Device 4 Drug-eluting Intraluminal Device D Intraluminal Device Z No Qualifier

37 Coding Example Bilateral - Myringotomy and tympanostomy tube insertion Section0 Medical and Surgical Body System9 Ear, Nose, Sinus Operation 9 Drainage: Taking or letting out fluids and/or gases from a body part 37

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 DeviceZ No Qualifier 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 Z No DeviceX Diagnostic Z No Qualifier 5 Middle Ear, Right 6 Middle Ear, Left 9 Auditory Ossicle, Right A Auditory Ossicle, Left D Inner Ear, Right E Inner Ear, Left 0 Open0 Drainage DeviceZ No Qualifier 38

39 Answer Z AND Z 5 is middle ear, right and 6 is middle ear, left 39

40 Questions 40


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