1. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 16-1 Chapter 16 Introduction to ICD-10-PCS

2. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Objectives LO 16.1 Define the objectives that guided the development of ICD-10-PCS. LO 16.2 Properly interpret ICD-10-PCS code descriptions. LO 16.3 Identify the structure of ICD-10- PCS codes. 16-2

3. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Objectives (cont.) LO 16.4 Recognize the proper ways to use the alphabetic index and the tables section of ICD-10-PCS. LO 16.5 Discern the general conventions for using ICD-10-PCS. 16-3

4. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Objectives (cont.) LO 16.6 Determine the principal ICD-10- PCS code and proper sequencing for multiple procedure codes. LO 16.7 Employ GEMS to support transitioning from ICD-9-CM Volume 3 to ICD-10-PCS. 16-4

5. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms Approach Body part Body system Completeness Device Expandability 16-5

6. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Multiaxial Qualifier Root operation term Standardized terminology Structural integrity Unique definitions 16-6

7. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. ICD-10-PCS Replaces ICD-9-CM Volume 3 More specificity for various procedures Easier to incorporate new procedures as they develop 16-7

8. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Objectives for ICD-10-PCS Six objectives 1.Completeness Unique codes for each procedure and for any possible procedures have been created 2.Expandability Can easily accept new procedures and incorporate them logically into the existing list 16-8

9. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Objectives for ICD-10-PCS (cont.) Six objectives (cont.) 3.Multiaxial Characters used consistently within each section 4.Standardized terminology Uses only one meaning for each term 16-9

10. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Objectives for ICD-10-PCS (cont.) Six objectives (cont.) 5.Unique definitions Each code can maintain its unique definition without affecting the incorporation of new methodology 6.Structural integrity Structure of existing codes can be maintained while still expanding the set to include new technology 16-10

11. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. ICD-10-PCS Code Descriptions Procedure descriptions will no longer include diagnostic information –The description of each procedure code is limited to the details of the procedure itself 16-11

12. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. ICD-10-PCS Code Descriptions (cont.) Not otherwise specified (NOS) options are omitted –A minimum amount of detail regarding each portion of the procedure is required 16-12

13. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. ICD-10-PCS Code Descriptions (cont.) Not elsewhere classified (NEC) options are reduced –Due to the added levels of specificity, the need for the NEC option is reduced 16-13

14. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Structure of ICD-10-PCS Codes Seven characters Alphanumeric Each position represents specific information 16-14

15. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Structure of ICD-10-PCS Codes (cont.) Character Position–Related Piece of Information 1. Section of the ICD-10-PCS code set 2. Body system upon which the procedure or service was performed 3. Root operation explains the category or type of procedure 4. Body part identifies the specific anatomical site involved in the procedure 16-15

16. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Structure of ICD-10-PCS Codes (cont.) Character Position–Related Piece of Information 5. Approach reports which method was used to perform the service or treatment 6. Device reports, when applicable, what type of device was involved in the service or procedure 7. Qualifier adds any additional detail 16-16

17. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Structure of ICD-10-PCS Codes (cont.) Sections (First Character) 16-17

18. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Structure of ICD-10-PCS Codes (cont.) Body Systems (Second Character) –The Medical and Surgical section of ICD-10- PCS has the largest number of body systems to be reported. 16-18

19. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Structure of ICD-10-PCS Codes (cont.) 16-19

20. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Structure of ICD-10-PCS Codes (cont.) 16-20

21. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Structure of ICD-10-PCS Codes (cont.) Root Operations (Third Character) 16-21

22. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Structure of ICD-10-PCS Codes (cont.) Body Part (Fourth Character) –Information regarding the specific body part, anatomical site, or body region upon which the procedure, service, or treatment was performed 16-22

23. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Structure of ICD-10-PCS Codes (cont.) Approach (Fifth Character) –Reports the technique or methodology used during the procedure 16-23

24. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Structure of ICD-10-PCS Codes (cont.) Device (Sixth Character) –Identifies a device used in the procedure –Any item that will remain in or with the body after the procedure is complete 16-24

25. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Structure of ICD-10-PCS Codes (cont.) Qualifier (Seventh Character) –Reporting whatever additional information may be needed 16-25

26. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The Structure of ICD-10-PCS Codes (cont.) Placeholder Characters –Z means “not applicable” or “none” –Z placeholder will be used most often as the seventh character 16-26

27. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The ICD-10-PCS Book The Alphabetic Index –Primarily sorted by root operation terms –Body system –Body part 16-27

28. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The ICD-10-PCS Book (cont.) Tables –Each section is in order by the first character in the code First character: Section (such as Medicine, Mental Health, Imaging) Second character: Body system Third character: Root operation 16-28

29. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. The ICD-10-PCS Book (cont.) Tables (cont.) Fourth character: Body part or region Fifth character: Approach Sixth character: Device Seventh character: Qualifier 16-29

30. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. ICD-10-PCS General Conventions Guidelines –A1. ICD-10-PCS codes are composed of seven characters –A2. One of 34 possible values can be assigned to each axis of classification in the seven-character code 16-30

31. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. ICD-10-PCS General Conventions (cont.) Guidelines (cont.) –A3. The valid values for an axis of classification can be added to as needed –A4. The meaning of any single value is a combination of its axis of classification and any preceding values on which it may be dependent 16-31

32. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. ICD-10-PCS General Conventions (cont.) Guidelines (cont.) –A5. Over time more values will depend on preceding values for their meaning –A6. The PCS tables should always be consulted to find the most appropriate valid code 16-32

33. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. ICD-10-PCS General Conventions (cont.) Guidelines (cont.) –A7. 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 16-33

34. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. ICD-10-PCS General Conventions (cont.) Guidelines (cont.) –A8. All seven characters must be specified to be a valid code –A9. Valid codes include all combinations of choices in characters 4 through 7 contained in the same row of the table 16-34

35. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Selection of Principal Procedure Always determined in coordination with the diagnosis codes being reported to identify the medical necessity for performing these procedures 16-35

36. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Selection of Principal Procedure (cont.) 16-36

37. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. General Equivalence Mappings (GEMs) Connection between an ICD-9-CM Volume 3 code and its ICD-10-PCS code equivalent 16-37

38. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter Summary The purpose of this chapter is to provide an overview of ICD-10-PCS, giving you an idea of what to expect. Establish a comfort level so that you are not apprehensive about the new system. 16-38