1. ICD-10-PCS Structure, Format, and Table Conventions27
Chapter Twenty-Seven
ICD-10-PCS Structure, Format, and Table Conventions

2. Learning Outcomes After completing this chapter, you will be able to:
27.1 Outline the history and development of ICD- 10-PCS.
27.2 Describe the standardized terminology of ICD-10-PCS codes.
27.3 Demonstrate how to build an ICD-10-PCS code.
Teaching Notes:
Provide students with an overview of presentation topics.

3. Learning Outcomes (cont.)
27.4 Apply the structure of the ICD-10-PCS manual to build codes.
27.5 Discuss the documentation and knowledge requirements for the accurate assignment of ICD-10-PCS codes.
Teaching Notes:
Provide students with an overview of presentation topics.

4. Key Terms multi-axial codes approach qualifier body part
root operation
standardized terminology
structural integrity
table
unique definition
value
approach
body part
body system
character
completeness
device
eponyms
expandability
Teaching Notes:
When defining key terms, determine which terms are already known and have students explain their understanding of the terms.
Explain those terms that are unknown, answering any questions and giving real-world examples as applicable.

5. 27.1 History and Development of ICD-10-PCS
Six major attributes
Completeness
Unique definitions
Expandability
Multi-axial codes
Standardized terminology
Structural integrity
Learning Outcome Outline the history and development of ICD-10-PCS.
Page:
Teaching Notes:
Discuss the six major attributes of the ICD-10-PCS:
1. Completeness
The characteristics of each code provide a comprehensive, significant, and unique code. ICD-10-PCS codes are built using six characters, which address six aspects that define medical and surgical procedures and services. This not only provides completeness to the code but also requires complete evaluation of the documentation on which the code will be assigned.
2. Unique definitions
Codes are custom-built to define each unique procedure. The nature of ICD-10-PCS codes provides consistency that does not allow for the recycling of codes to later be assigned to report a procedure that is defined differently in any way.
3. Expandability
Also helps fulfill the attribute of unique definitions, as there is sufficient room for adding new values for characters as new procedures and technology are developed. In addition, this supports the attribute of structural integrity, which allows expansion without disrupting the structure of the system.
4. Multi-axial
The ICD-10-PCS code structure contains characters that are independent yet maintain consistency within defined sections.
5. Standardized terminology
In ICD-10-PCS, each term has a unique meaning. These terms are used to provide the code descriptions, rather than using terms documented by providers that may have ambiguous meanings. Eponyms and diagnostic information are also not included in the standardized terminology, as they do not provide information specific to the procedure performed.
6. Structural integrity
Because codes are custom-built, expansion for new procedure codes does not disrupt the integrity of the coding system. New character values may be added, as necessary, but the structure of the system will not change when this occurs. The attribute of structural integrity enables the ICD-10-PCS system to evolve

6. 27.1 History and Development of ICD-10-PCS
ICD-10-PCS Coding Guideline A1
All codes are seven characters.
Each character is an axis, specifying same information for a defined code range.
Example: The fifth axis of classification specifies the approach in sections 0 through 4 and 7 through 9 of the system.
Learning Outcome Outline the history and development of ICD-10-PCS.
Page: 470
Teaching Notes:
Locate the coding guidelines.
Read the coding guidelines.
Assign segments of the coding guidelines for homework and subsequent class discussion and participation.
Assign a percentage of the overall grade to students’ ability to demonstrate competency in using the guidelines.
Identify characters that make up a code.
Discuss information for a defined code range.
Provide examples.

7. 27.1 History and Development of ICD-10-PCS
ICD-10-PCS Coding Guideline A3
Ability to add values for a classification axis
Example: A new device value may be added if a new procedure uses a significantly distinct type of device.
Learning Outcome Outline the history and development of ICD-10-PCS.
Page: 470
Teaching Notes:
Discuss ICD-10-PCS coding guidelines A3 and the ability to add values for a classification axis.
Provide examples.

8. 27.2 Standardized Terminology of the ICD-10-PCS Codes
ICD-10-PCS Coding Guideline A2
For each axis of classification in the seven- character codes, there are 34 possible values, consisting of the numeric digits 0–9 and the letters A–H, J–N, and P–Z.
Note that the letters I and O are not used. The rationale for omitting those values is to avoid confusion with the numbers 1 and 0.
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 471
Teaching Notes:
Discuss the possible values for alpha-numeric codes.

9. 27.2 Standardized Terminology of the ICD-10-PCS Codes
Format of ICD-10-PCS Codes 1 2 3 4 5 6 7
Section
Body system
Root operation
Body part
Approach
Device
Qualifier
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 471
Teaching Notes:
Discuss the format of ICD-10-PCS codes.
Provide examples of the various body systems that may be described by code, various types of root operations, and body parts operated on.
Provide examples of the various types of surgical approaches that may be used.
Provide examples of the various devices that may be used during medical and surgical procedures.

10. 27.2 Standardized Terminology of the ICD-10-PCS Codes
Character Values for Sections
Medical and Surgical 1
Obstetrics 2
Placement 3
Administration 4
Measurement and Monitoring 5
Extracorporeal Assistance and Performance 6
Extracorporeal Therapies 7
Osteopathic
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 472
Teaching Notes:
Identify sections found within the ICD-10-PCS
Briefly discuss character values for each.
Provide some specific examples of the types of procedures found within the ICD-10-PCS.
Identify procedures.
Define procedures (e.g. What is Extracorporeal Assistance and Performance?).
List any coding rules or instructional notation related to procedures.
List any relevant questions to ask yourself related to coding from these sections.

11. 27.2 Standardized Terminology of the ICD-10-PCS Codes
Character Values for Sections (cont.) 8
Other Procedures 9
Chiropractic B
Imaging C
Nuclear Medicine D
Radiation Oncology F
Physical Rehabilitation and Diagnostic Audiology G
Mental Health H
Substance Abuse Treatment
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 472
Teaching Notes:
Discuss the character values for a variety of sections found within the ICD-10-PCS.
Identify sections found within the ICD-10-PCS
Briefly discuss character values for each.
Provide some specific examples of the types of procedures found within the ICD-10-PCS.
Identify procedures.
Define procedures (e.g. What is Nuclear Medicine?).
List any coding rules or instructional notation related to procedures.
List any relevant questions to ask yourself related to coding from these sections.

12. 27.2 Standardized Terminology of the ICD-10-PCS Codes
Character 2 Meanings for Sections
Body system 1 2 3 4 5
Physiological system 6 7
Anatomic system
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 472
Teaching Notes:
Discuss the meaning ascribed for character 2 of the codes for ICD-10-PCS.
Explain the difference between body systems, physiological systems, and anatomic systems.

13. 27.2 Standardized Terminology of the ICD-10-PCS Codes
Character 2 Meanings for Sections (cont’d) 8
Body system 9
Anatomic regions B C D F
Section qualifier G H
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 472
Teaching Notes:
Discuss the meaning ascribed for character 2 of the codes for ICD-10-PCS.
Explain the difference between body systems, anatomic regions, and section qualifiers.

14. 27.2 Standardized Terminology of the ICD-10-PCS Codes
Character 3 Meanings for Sections
Root operation 1 2 3 4 5 6 7
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 473
Teaching Notes:
Explain the meaning ascribed to character 3 for sections found within the ICD-10-PCS.
Define root operation and provide examples.

15. 27.2 Standardized Terminology of the ICD-10-PCS Codes
Character 3 Meanings for Sections (cont’d) 8
Root operation 9 B
Root type C D F G H
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 473
Teaching Notes:
Explain the meaning ascribed to character 3 for sections of the ICD-10-PCS.
Define root operation and root type and provide examples of each.

16. 27.2 Standardized Terminology of the ICD-10-PCS Codes
Character 4 Meanings for Sections
Body part 1 2
Body region 3
Body system/region 4
Body system 5 6 7
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 474
Teaching Notes:
Explain the meaning ascribed to character 4 of the sections found within the ICD-10-PCS.
Differentiate between body parts, body systems, and body regions found within these sections.
Provide examples.

17. 27.2 Standardized Terminology of the ICD-10-PCS Codes
Character 4 Meanings for Sections (cont’d) 8
Body region 9 B
Body part C D
Treatment site F
Body system/region G
Type qualifier H
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 474
Teaching Notes:
Explain the meaning ascribed to character 4 of the sections found within the ICD-10-PCS.
Define body regions, body parts, treatment sites, body systems, and type qualifier and provide examples of each.

18. 27.2 Standardized Terminology of the ICD-10-PCS Codes
Character 5 Meanings for Sections
Approach 1 2 3 4 5
Duration 6 7
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 475
Teaching Notes:
Explain the meaning ascribed to character 5 of the sections found within the ICD-10-PCS.
Identify and define approaches used and the duration of procedures identified by character 5 of the codes within this section.

19. 27.2 Standardized Terminology of the ICD-10-PCS Codes
Character 5 Meanings for Sections (cont’d) 8
Approach 9 B
Contrast C
Radionuclide D
Modality qualifier F
Type qualifier G
Qualifier H
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 475
Teaching Notes:
Explain the meaning ascribed to character 5 of these sections for ICD-10-PCS codes.
Identify and define medical or surgical approaches, types of contrast, and radionuclides used in medical and surgical procedures.
Identify and define modes by which procedures are performed as attributed to qualifier character.
Identify types of qualifiers and their meanings based upon specific procedures.

20. 27.2 Standardized Terminology of the ICD-10-PCS Codes
Character 6 Meanings for Sections
Device 1 2 3
Substance 4
Function/device 5
Function 6
Qualifier 7
Method
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 476
Teaching Notes:
Explain the meaning ascribed to character 5 of these sections for ICD-10-PCS codes.
Identify and define medical or surgical approaches, types of contrast, and radionuclides.
Identify and define modes by which procedures are performed as attributed to qualifier character.
Identify types of qualifiers and their meanings based upon specific procedures.

21. 27.2 Standardized Terminology of the ICD-10-PCS Codes
Character 6 Meanings for Sections (cont’d) 8
Method 9 B
Qualifier C D
Isotope F
Equipment G H
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 476
Teaching Notes:
Explain the meaning ascribed to character 6 of these sections of the ICD-10-PCS.
Identify and define a variety of methods utilized during medical and surgical procedures, in addition to isotopes and equipment used.
Identify various unique components or attributes of medical or surgical procedures classified by use of a qualifying character.

22. 27.2 Standardized Terminology of the ICD-10-PCS Codes
ICD-10-PCS Coding Guideline A4
Single values have no meaning without the context of the combination of classification and other values that compose a code.
Example: Body part character value of 0 has varied meanings, depending on the body system. In the central nervous system, the body part character value of 0 represents the brain, but in the peripheral nervous system it represents the cervical plexus.
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 476
Teaching Notes:
Discuss the meaning of code characters within the context of a combination of characters making up a complete code.
Provide examples of codes and define attributes of each in the context of a complete code.

23. 27.2 Standardized Terminology of the ICD-10-PCS Codes
ICD-10-PCS Coding Guideline A5
With increasing detail in the coding system, eventually more of the character values will become dependent on the values of the preceding characters to determine their meaning.
Example: Device character value of 3 in the lower joints body system represents “infusion device” with the root operation of “insertion,” but it represents “interbody fusion device” with the root operation of “fusion.”
Learning Outcome Describe the standardized terminology of ICD-10-PCS codes.
Page: 476
Teaching Notes:
Identify and define what characters represent for codes found within the ICD-10-PCS.
Provide examples of procedures.
Define any procedures identified.
(e.g. What is an infusion device? In what context is it used and for what purpose?)
(e.g. What is a fusion? Identify operations in which this procedure may be performed to round out students’ understanding of concepts.)

24. 27.3 Building ICD-10-PCS Codes
Step 1 – Identify procedure for coding
Step 2 – Search index for main term
Step 3 – Reference the tables section for the first three characters
Step 4 – Identify values for characters 4-7
Learning Outcome Demonstrate how to build an ICD-10-PCS code.
Page:
Teaching Notes:
Provide students with specific coding examples and allow them to search the ICD-10-PCS alphabetical index for main terms.
Show students how to reference the tables in order to build complete codes.
In order to expound upon students’ acquisition of knowledge needed for practical purposes, you may also wish to do the following:
Not only explain specific values assigned for classification purposes but define, in whatever detail necessary, the procedures in the context by which they may be found and understood when reading medical record documentation for reporting procedures accurately.
For example, identify the procedure as a coronary artery bypass graft. Define the procedure as harvesting blood vessels from one location (e.g. great saphenous vein of the leg or mammary artery) to graft an accessory pathway within a blocked blood vessel found within the heart of the cardiovascular system. You may briefly explain why the vessel was blocked and why the procedure is performed.
Further identify specific coding rules and instructional notation relevant to any examples you may provide.
Students may wish to keep a notebook with rules pertaining to specific scenarios for future reference.

25. 27.3 Building ICD-10-PCS Codes
ICD-10-PCS Coding Guideline A9
The tables in ICD-10-PCS are carefully constructed so that only valid code combinations exist in each table.
Learning Outcome Demonstrate how to build an ICD-10-PCS code.
Page: 478
Teaching Notes:
Provide students with specific examples by which they may gain practice in building codes.
Show students how to correctly use the columns and rows found with the tables of ICD-10-PCS.

26. 27.4 Using the Structure of the ICD-10-PCS Manual to Build Codes
Example of index: Fragmentation Ampulla of Vater 0FFC Anus 0DFQ Appendix 0DFJ Bladder 0TFB Bladder Neck 0TFC
Learning Outcome Apply the structure of the ICD-10-PCS manual to build codes.
Page:
Teaching Notes:
Provide examples by which students may explore the index and tables found within the ICD-10-PCS.

27. 27.4 Using the Structure of the ICD-10-PCS Manual to Build Codes
Section
Body System
Operation
0 Medical and Surgical
T Urinary System
F Fragmentation: Breaking solid matter in a body part into pieces
Body Part
Approach
Device
Qualifier
3 Kidney Pelvis, Right
4 Kidney Pelvis, Left
6 Ureter, Right
7 Ureter, Left
B Bladder
C Bladder neck
D Urethra
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
7 Via Natural or Artificial Opening
8 Via Natural or Artificial Opening Endoscopic
X External
Z No Device
Z No Qualifier
Learning Outcome Apply the structure of the ICD-10-PCS manual to build codes.
Page: 479
Teaching Notes:
Show students how to correctly follow the columns and rows found within the ICD-10-PCS manual.
Identify specific body parts.
Identify and define specific approaches used when performing medical and surgical procedures.
Identify and define any devices and qualifiers that exist pertaining to medical and surgical procedures identified.

28. 27.4 Using the Structure of the ICD-10-PCS Manual to Build Codes
ICD-10-PCS Manual Appendices
Appendix A
Root Operations Definitions
Appendix B
Comparisons of Medical and Surgical Root Operations
Appendix C
Body Part Key
Appendix D
Type and Type Qualifier Definitions Sections B-H
Appendix E
Components of the Medical and Surgical Approach Definitions
Appendix F
Character Meanings
Learning Outcome Apply the structure of the ICD-10-PCS manual to build codes.
Page: 480
Teaching Notes:
Explain what information the various appendices provide.
Describe how the information found within the various appendices can be used.
Define root operations.
Provide examples of root operations. (Appendix A)
How might root operations for medical and surgical procedures be compared? (Appendix B)
What is the body part key? Explain its usefulness. (Appendix C)
In what ways might medical and surgical procedures be qualified based upon their unique characteristics? (Appendix D)
What are the various components of medical and surgical approaches? How might each be defined? (Appendix E)
What are the meanings of a variety of characters found within ICD-10-PCS as used within the context of complete codes for medical and surgical procedures?

29. 27.5 Knowledge and Documentation Requirements
Knowledge Requirements
Medical terminology
Anatomy and physiology
Technical concepts
Standardized terminology definitions
Learning Outcome Discuss the documentation and knowledge requirements for the accurate assignment of ICD-10-PCS codes.
Page:
Teaching Notes:
Explain what type of knowledge is required in order to code accurately.
Examples may be drawn from previous and existing course work.
Case study examples may be provided for supplementary practice.
When using scenarios and/or case studies, have students identify medical terminology, anatomy and physiology, technical concepts related to procedures performed, and any other standardized terminology relevant to accurate code assignment.

30. 27.5 Knowledge and Documentation Requirements
Increased need in comparison to ICD-9-CM
Audits
Internal
External
Educational follow-up after audits
Learning Outcome Discuss the documentation and knowledge requirements for the accurate assignment of ICD-10-PCS codes.
Page:
Teaching Notes:
What are the documentation requirements for ICD-10-PCS code assignment?
Have students explore their procedural coding manual information to discover ways in which medical record documentation must be made clear in order to correctly assign codes.
Pay particular attention to official coding guidelines, instructional notation, and coding conventions.
Clearly define foundational knowledge as it pertains to any procedures performed.
For Example:
What are the procedures? Why are they performed? What diagnosis is linked to the procedure for reporting medical necessity?
What is an internal audit? What is an external audit? How are they performed?
How might training and development for continuous quality improvement in coding bring about better outcomes when audits are performed?

31. Summary CMS is responsible for maintaining ICD-10-PCS code set.
Six major attributes
Seven characters with up to 34 different values
Locate main term in index, then refer to tables
ICD-10-PCS manual includes a procedure index, a tables section, and six appendices.
Teaching Notes:
Summarize concepts discussed in order to reinforce students’ learning.
Allow for questions and answers to clarify concepts.
Check students’ understanding of Chapter 27.
Complete chapter review in class or assign as homework to reinforce comprehension.