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Crossing the Bridge Preparing for ICD-10-PCS Crystal Clack, MS, RHIA, CCS AHIMA Approved ICD-10-CM/PCS Trainer OrHIMA Fall Conference 2013.

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Presentation on theme: "Crossing the Bridge Preparing for ICD-10-PCS Crystal Clack, MS, RHIA, CCS AHIMA Approved ICD-10-CM/PCS Trainer OrHIMA Fall Conference 2013."— Presentation transcript:

1 Crossing the Bridge Preparing for ICD-10-PCS Crystal Clack, MS, RHIA, CCS AHIMA Approved ICD-10-CM/PCS Trainer OrHIMA Fall Conference 2013

2 Objectives  A Brief History  ICD-9-CM, Vol. 3 to ICD-10-PCS  Format and Structure of ICD-10-PCS  Spotlight: Root Operations  Practice  Preparing for the Great Transition  Conclusion  Resources

3 A Brief History

4 Why Now? ICD-10-PCS is completely different from ICD-9-CM, Vol. 3 Multi-axial structure Completeness Expandability Standardized terminology Standardized level of specificity No explicit options of “NOS” and limited use of “NEC” code

5 ICD-9-CM Vol. 3 vs ICD-10-PCS ICD-9-CM Volume 3ICD-10-PCS Follows ICD structure (designed for DX coding) Designed and developed to meet healthcare needs for a procedure coding system Codes available as fixed and finite set in list form Codes constructed from flexible code components using Table Codes are 3 to 4 digits long with a decimal point places after the second digit Codes are 7 characters long Codes are numericCodes are alphanumeric

6 Number of Codes in ICD-10-PCS at the time of printing the 2014 Official Draft Code Set manual: 71,924 For 2014, seven new technology codes were added to the system, and three were deleted.

7 Format & Structure Manual contains an Index and Table section Codes may be found in the index based on the general type of procedure. Based on the first three values of the code provided in the Index, the table that corresponds to the procedure can be referenced to complete the entire code. Tables and characters are arranged as follows: Number Letter for each character, with a total of 7 characters IMPORTANT: The Tables must be used to paint a complete and accurate picture!

8 ICD-10-PCS Format & Structure Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Operation Body Part ApproachDeviceQualifier Each code is seven characters and can be alphabetical or numeric Ten digits 0-9 and 24 letters A-H, J-N, and P-Z are used Each of the characters has a well-defined meaning

9 Section ~ Character 1 Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Operation Body Part ApproachDeviceQualifier All Codes in PCS are seven characters Letters O and I are not used – 0 and 1 are used Each number has a meaning Meanings change depending on sections Section provides first character value

10 Section Medical procedures are divided into sections that identify the general type of procedure. The first character of the procedure code always specifies the section – or where you can locate the code in the book.

11 Sections of ICD-10-PCS as follows: ValueSectionValueSection 0Medical & Surgical9Chiropractic 1ObstetricsBImaging 2Placement CNuclear Med 3Administration DRadiation Tx 4Measuring & Monitoring F Physical Rehab & Diagnostic Audiology 5 Extracorporeal Assistance & Performance GMental Health 6Extracorporeal Therapies H Substance Abuse Treatment 7Osteopathic BOLD italics = Ancillary 8Other Procedures

12 Body System~ Character 2 Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Operation Body Part ApproachDeviceQualifier Second character Body System, general physiological system or anatomical region involved Review Body Systems in training manual Appendix G

13 Body System 0 - Central Nervous Sys.C – Mouth & ThroatQ – Lower Bones 1 – Peripheral Nervous SysD – Gastro SystemR – Upper Joints 2 – Heart & Great Vessels F – Hepatobiliary System & Pancreas S – Lower Joints 3 – Upper ArteriesG – Endocrine SystemT – Urinary System 4 – Lower ArteriesH – Skin & Breast U – Female Reproductive System 5 – Upper VeinsJ – SQ Tissue & Fascia V – Male Reproductive System 6 – Lower VeinsK – Muscles W – Anatomical Regions, General 7 – Lymphatic & HemicL - Tendons X – Anatomical Regions, Upper Extremities 8 – EyeM – Bursae & Ligaments Y – Anatomical Regions, Lower Extremities 9 – Ear Nose & SinusN – Head & Facial Bones B – Respiratory SystemP – Upper Bones

14 Root Operations ~ Character 3 Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Operation Body Part ApproachDeviceQualifier Objective of Procedure 31 root operations Arranged by similar attributes Multiple codes

15 Examples of Root Operations  Bypass  Drainage  Reattachment  Resection  Inspection

16 Root Operations AlterationDivisionInspectionReposition BypassDrainageMapResection ChangeExcisionOcclusionRestriction ControlExtirpationReattachmentRevision CreationExtractionReleaseSupplement DestructionFragmentationRemovalTransfer DetachmentFusionRepairTransplantation DilationInsertionReplacement There are 31 different root operations! The root is the reason, or objective, for the procedure

17 Body Part ~ Character 4 Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Operation Body Part ApproachDeviceQualifier Fourth character Anatomical site for procedure 34 possible values per body system

18 Examples of Body Parts  Liver  Kidney  Thalamus  Ascending Colon  Optic Nerve  Tonsil  Axillary vein, left  Radial nerve  Cerebellum  Upper lung lobe (R)

19 Approach ~ Character 5 Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Operation Body Part Approach DeviceQualifier Fifth character – approach or technique used to reach procedure Seven different approach values May be through: skin, mucous membrane, orifice or external

20 Examples of Approaches  Skin or Mucous Membranes ~ Open, percutaneous or percutaneous endoscopic  Through an Orifice ~ Via Natural or Artificial Opening ~ Via Natural or Artificial Opening Endoscopically ~ Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance  External

21 Root Operations~ Character 5 Approach contains three components: Access location Method Type of instrumentation Types of approaches: Open Percutaneous & percutaneous endoscopic Via natural/artificial Opening Natural/Artificial Opening Endoscopic Natural/Artificial Opening with Percutaneous Endoscopic Assistance External

22 Device ~ Character 6 Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Operation Body Part Approach Device Qualifier Only procedures with a remaining device after the procedure will have a specific device value. All codes require seven characters. The default value to indicate that NO device was involved is Z. Materials incidental to the procedure (clips and sutures) are not considered devices.

23 Four Groups of Devices  Grafts  Prostheses  Implants  Simple or Mechanical Appliances  Electronic Appliances

24 Qualifier ~ Character 7 Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Operation Body Part ApproachDevice Qualifier Provides additional information May have narrow application There are NO specific guidelines for qualifiers

25 Most procedures will not have an applicable qualifier…the default value to indicate that NO qualifier is necessary is…… Z TIP !

26 Simple Way to Remember the Seven Character Meanings! Sally=Selection Bought=Body System Root =Root Operation Beer=Body Part At=Approach Dairy=Device Queen=Qualifier

27 True or False? A biological or synthetic material that takes the place of all or a portion of a body part such as a joint prosthesis would qualify as a device in ICD-10-PCS. A:True Rationale:A device is specified in the sixth character and is used to identify devices that remain after the procedure is complete

28 Test Your Knowledge 1.All ICD-10-PCS codes have _____________ characters. a.3 to 5 b.3 to 7 c.5 to 7 d.7 2. Materials such as sutures, ligatures, radiological markers, and temporary postop wound drains should be coded separately using ICD-10-PCS device codes a. True b. False 3.When coding in ICD-10-PCS, it is necessary to consult the Alphabetic Index and then proceed to the Tables. a. True b. False

29 Medical and Surgical Section (0): Root Operations ROOT OPERATIONS There are 31 root operations in ICD-10-PCS; each identifies the objective of a procedure and holds the key to the highly specific details and precision of the code values.

30 Root Operation Guidelines B3. Root Operation - General guidelines B3.1a. In order to determine the appropriate root operation, the full definition of the root operation as contained in the PCS Tables must be applied B3.1b Components of a procedure specified in the root operation definition are not coded separately. Procedural steps necessary to reach the operative site and close the operative site are also not coded separately. EXAMPLES: Resection of a joint as part of a joint replacement procedure is included in the root operation definition of Replacement and is not coded separately. Laparotomy performed to reach the site of an open liver biopsy is not coded separately. In a resection of sigmoid colon with anastomosis of descending colon to rectum, the anastomosis is not coded separately.

31 B3. Root Operation - General guidelines continued: B3.2.Multiple Procedures: During the same operative episode, multiple procedures are coded if: a. The same root operation is performed on different body parts as defined by distinct values of the body part character. b. The same root operation is repeated at different body sites that are included in the same body part value. c. Multiple root operations with distinct objectives are performed on the same body part d. The intended root operation is attempted using one approach, but it converted to a different approach

32 B3. Root Operation - General guidelines continued: B3.3.Discontinued Procedures: If the intended procedure is discontinued, code the procedure to the root operation performed. If a procedure is discontinued before any other root operation is performed, code the root operation inspection of the body part or anatomical region inspected B3.4a.Biopsy Procedures: Are coded using the root operations, Extraction, or Drainage and the qualifier Diagnostic. The qualifier Diagnostic is ONLY used for biopsies B3.4b.Biopsy followed by a more definitive treatment: If a diagnostic Excision, Extraction, or Drainage procedure is followed by a more definitive procedure, such as Destruction, Excision or Resection at the same procedure site, both the biopsy and more definitive treatment are coded

33 Medical & Surgical Section: Root Operations That Take Out Some/All of a Body Part Excision B: Definition: Cutting out or off, without replacement, a portion of a body part Explanation: The qualifier DIAGNOSTIC is used to identify excision procedures that are biopsies Examples: Partial Nephrectomy, Liver biopsy

34 Example Case One A 32-year-old female patient experienced melena gradually worsening over the last five days. Patient complains of weakness and dizziness to the point of passing out at work. She was admitted to the hospital for observation and an EGD. An EGD of the duodenum was performed the following morning. What is the ICD-10-PCS code for this procedure? Root operation: _________________________________ Specific Body Part:_________________________________ Seventh Character:_________________________________ ICD-10-PCS Code:_________________________________

35 Example Case One Snapshot of PCS Coding Book

36 Answer Case One What is the ICD-10-PCS code for this procedure? Root operation: Excision Specific Body Part:Duodenum identified with 4 th character Seventh Character:“X” for diagnostic ICD-10-PCS Code:0DB98ZX

37 Medical & Surgical Section: Root Operation - Resection Resection - T: Definition: Cutting out, or off, without replacement, all of a body part Explanation: N/A Examples: Total Nephrectomy, total lobectomy of lung

38 Example Case Two A 45-year-old male patient was diagnoses with acquired hemolytic anemia, autoimmune type with warm-reactive antibodies, and has been treated with glucocoricoids. Given the aggressive nature of his anemia, he was advised to have a total splenectomy to eliminate the body’s further destruction of red blood cells. Open splenectomy was performed without complications. What is the ICD-10-PCS code for this procedure? Root operation: _________________________________ Specific Body Part:_________________________________ Seventh Character:_________________________________ ICD-10-PCS Code:_________________________________

39 Example Case Two Snapshot of PCS Coding Book

40 Answer Case Two What is the ICD-10-PCS code for this procedure? Root operation: Resection Specific Body Part:No device Seventh Character:No qualifier ICD-10-PCS Code:07TP0ZZ

41 Medical & Surgical Section: Root Operations That Always Involve a Device B6. Device 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 such a sutures, ligatures, radiological markers and temporary post-operative wound drains are considered integral to the performance of a procedure and not coded as devices. B6.1.c. Procedures performed on a device only and not on a body part are specified in the root operations Change, Irrigation, Removal and Revision and are coded to the procedure performed.

42 Medical & Surgical Section: Root Operation - Replacement Replacement - R: Definition: Putting in or on a biological or synthetic material that physically takes the place and/or function of all or a portion of the body part. Explanation: The body part may have been taken out or replaced, or may be taken out, physically eradicated or rendered nonfunctional. A Removal procedure is coded for taking out the device used in previous replacement procedure.

43 Example Case Three The patient had a total right knee replacement 9 years ago. The patient was found to have an aseptic loosening and it was recommended to have total knee revision arthroplasty. The patient was taken to the OR where a ® TKR revision was carried out. During the procedure the previous prosthetic device was removed and a new cemented prosthetic device was inserted. What is the ICD-10-PCS code for this procedure? Root operation: _________________________________ Specific Body Part:_________________________________ Seventh Character:_________________________________ ICD-10-PCS Code:_________________________________

44 Example Case Three Snapshot of PCS Coding Book

45 What is the ICD-10-PCS code for this procedure? Root operation: Replacement Specific Body Part:Knee component and laterality Seventh Character:cemented ICD-10-PCS Code:0SRC0J9 Answer Case Three

46 DO WE HAVE TO CLIMB THAT?!

47 Preparing for the Inevitable: 10/01/2014

48 Don’t be a Fish out of Water! Brush up on your anatomy Review your pathophysiology Don’t procrastinate! START NOW

49 Many, Many Web Resources! 1.http://www.ahima.org/icd10/http://www.ahima.org/icd10/ 2.http://www.aapc.com/icd-10/http://www.aapc.com/icd-10/ 3.http://www.cms.gov/Medicare/Coding/ICD10/index.html?redire ct=/icd10http://www.cms.gov/Medicare/Coding/ICD10/index.html?redire ct=/icd10 4.http://www.himss.org/library/icd-10/playbook?navItemNumber=13480http://www.himss.org/library/icd-10/playbook?navItemNumber= http://health-information.advanceweb.com/ICD-10-Resource- Center/default.aspxhttp://health-information.advanceweb.com/ICD-10-Resource- Center/default.aspx 6.www.fortherecordmag.comwww.fortherecordmag.com

50  Application of ICD-10-PCS Root Operations, Audio Seminar, October 23, 2012 AHIMA  ICD-10-CM Official Guidelines for Coding and Reporting 2014:  ICD-10-PCS Code Set:  ICD-10-PCS, The Complete Official Draft Code Set 2014, Optum  Root Operations: Key to Procedure Coding in ICD-10-PCS, Ann Barta & Ann Zeisset, AHIMA, 2011 Resources Used

51 Summer, 2015…..Life is Good!


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