1. ICD-10-PCS
Beginning The Journey

2. ICD-10-PCS – Structure ICD-9-CM ICD-10-PCS ICD-9-CM has 3-4 characters
All characters are numeric
All codes have at least 3 characters
ICD-10-PCS has 7 characters
Each can be either alpha or numeric
Numbers 0-9; letters A-H, J-N, P-Z
Alpha characters are not case-sensitive
Each code must have 7 characters
The letters O and I are not used in ICD 10 PCS to avoid confusion with the numbers 0 and 1.
ICD-10
AHIMA

3. ICD-10-PCS - Structure
ICD-9-CM . 1 X X 2 4 X X 3
All procedure codes in ICD 10 PCS will have 7 characters. There are no decimal points. The PCS code is alpha numeric.
ICD-10-PCS 3 X 1 D E X B H X 5 X F 8 8 7 X Z X 3 4 X Z X
ICD-10
AHIMA

4. WHAT IS A ROOT OPERATION????
THE OBJECTIVE OR
ACTION OF THE PROCEDURE

5. 31 MEDICAL & SURGICAL ROOT OPERATIONS
There is a specific definition for each one of these roots
ICD-10-PCS uses terminology that coders are not accustomed to seeing on a chart
The purpose of this training is to help the coder smoothly transition to the new root operation and their meanings

6. SURGICAL & MEDICAL ROOT OPERATIONS (31)
Alteration
Division
Inspection
Reposition
Bypass
Drainage
Map
Resection
Change
Excision
Occlusion
Restriction
Control
Extirpation
Reattachment
Revision
Creation
Extraction
Release
Supplement
Destruction
Fragmentation
Removal
Transfer
Detachment
Fusion
Repair
Transplantation
Dilation
Insertion
Replacement

7. ICD-10-PCS - Structure Characters (Med/Surg)2 3 4 5 6 7
Root
Operation
Qualifier
Section
Approach
Body
System
Body Part
Device
ICD-10
AHIMA

8. First Character of the Procedure Code -Section
0 - Medical and Surgical 1 – Obstetrics 2 – Placement 3 - Administration 4 – Measurement and Monitoring 5 – Extracorporeal Assistance and Performance 6 – Extracorporeal Therapies 7 – Osteopathic 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
There are 16 sections in ICD 10 PCS which is the first character of the code.

9. Medical and Surgical section
Largest of the 16 sections
Same definition or meaning
Section B–D and F-H comprise the Ancillary section of ICD-10-PCS

10. Sec Second Character- Body System
General physiological system or anatomical region involved
Body System
Value
Central Nervous
Peripheral Nervous 1
Heart and Great Vessels 2

11. Third Character – Root Operation
Objective of the procedure
31 Root Operations
Examples of Root Operations
Bypass
Resection
Excision
Removal

12. Fourth Character – Body Part
Defines the body part or specific anatomical site where the procedure was performed
This is different from character 2 which provides the general Body System
There are 34 possible body part values in each body system
Examples of Body Parts are:
Liver
Kidney
Ascending Colon
Optic Nerve

13. Fifth Character - Approach
Defines the approach, or the technique used to reach the procedure site
There are seven different approach values in the Medical and Surgical section
Through Skin or mucous membrane
Through an orifice
External
Open
Natural or Artificial Opening
Percutaneous
Natural or Artificial Opening Endoscopic
Percutaneous Endoscopic
Natural or Artificial Opening with Percutaneous Endoscopic Assistance

14. Sixth Character - Devices
Identified devices that remain after the procedure is completed
Remember that all codes require seven characters
The default value to indicate that NO device was involved is Z
Examples of Device Values
Drainage Device
Radioactive Element
Extraluminal device
Intraluminal device
Autologous tissue substitute
Synthetic substitute

15. Seventh Character - Qualifier
Qualifier for the code that provides additional information about a specific attribute of the procedure
These qualifiers may have a narrow application, to a specific root operation, body system or body part
Most procedures will not have an applicable qualifier. The default value for NO qualifier is a Z
Examples of Qualifiers
Type of Transplant
Second site for a bypass
Diagnostic excision (biopsy)

16. EXAMPLE CODE
0LB50ZZ Excision of right lower arm and wrist tendon, open” 0 = Section – Medical and Surgical L = Body Section - Tendons B = Root Operation- Excision 5 = Body Part – Lower arm and wrist tendon, right 0 = Approach - Open Z = Device – No Device Z = Qualifier – No Qualifier

17. CODERS MUST LEARN NEW TERMINOLOGY
It is the coder’s responsibility to determine which root operation the documentation in the medical record equates to in the PCS definitions
Physicians will continue to use the same terminology they have always used in describing an operative procedure. For example, the surgeon will document a thrombectomy and not an “extirpation”. That is why it is important to learn and understand the 31 root operations.

18. PHYSICIAN TERMINOLOGY MAY NOT CHANGE
The physician is not expected to use the root terms provided in PCS code description
Nor
Is the coder required to query the physicians when the correlation between the documentation and the defined PCS term is clear.

19. EPONYMS ARE GONE IN ICD 10 PCS
Billroth I procedure equates to anastomosis

20. QUESTIONS