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ICD-10-PCS Boot Camp Presented by: Karen Kvarfordt, RHIA, CCS-P, CCDS President, DiagnosisPlus, Inc. 2014

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ICD-10-PCS Boot Camp. Presented by: Karen Kvarfordt, RHIA, CCS-P, CCDS President, DiagnosisPlus, Inc. 2014. Things will never be the same once we switch to ICD-10-PCS! Complete overhaul of the procedure classification system as we know it today. - PowerPoint PPT Presentation

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Page 1: ICD-10-PCS Boot Camp

ICD-10-PCS Boot Camp

Presented by: Karen Kvarfordt, RHIA, CCS-P, CCDS

President, DiagnosisPlus, Inc.2014

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Things will never be the same once we switch to ICD-10-PCS!

Complete overhaul of the procedure classification system as we know it today.

Tip! Refer to Appendix F: Character Meanings – this will save you!

But don’t panic, it can be easily mastered!

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ICD-10-PCS codes include one digit for the root operation that the physician performs. Root operation is always the 3rd character in

the seven character code. Start by reviewing the definitions of the

various root operations. If you learn the root operations early, you’ll have a head start on learning how to code in ICD-10-PCS.

More Tips…

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Always look first in the Alphabetic Index (will give you the first 3 or 4 characters) and then finish building the procedure code in the Tables.

Key! You can’t jump around in the tables. Need to go across to get your procedure code!

And The Best Tip!

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CMS awarded the contract to 3M Health Information Systems to develop a new procedure coding system for ICD-10.

New system is intended to replace ICD-9-CM Volume 3 for reporting hospital inpatient procedures.

But what about the outpatient side?

Who Developed The ICD-10-PCS System?

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Diagnostic information is not included in the code description.

A ‘not elsewhere classified’ option is allowed for new devices and substances.

All substantially different procedures are defined.

General Principles

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A general body part, approach, or root operation can be used when the level of specificity is not available in the record or cannot otherwise be obtained.

Should you query?

General Principles“Limited NOS” Option

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Body Part:◦Example: “Liver” is used when the specific liver lobe is not

identified. Approach:◦ “Open”, “Percutaneous” and “Via Natural or Artificial

Opening” are used when a more specific type of approach is not documented and cannot otherwise be determined.

Root Operation:◦ “Repair” is used when the procedure documentation does

NOT support a specific root operation and the information cannot otherwise be obtained.

Limited NOS Option

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ICD-9-CM (Volume 3) (Procedures)

◦Min. characters: 3◦Max. characters: 4◦Numeric format (+ V code)◦Decimal point◦3,000 procedure codes

ICD-10-PCS (Procedures)

◦Min. characters: 7◦Max. characters: 7◦Alphanumeric format◦No decimal point◦71,918 procedure

codes

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ICD-9-CM vs. ICD-10-PCS

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Section CodesMedical and Surgical** 61,896

Obstetrics 300

Placement 861

Administration 1,384

Measurement and Monitoring 339

Extracorporeal Assistance and Performance

41

Extracorporeal Therapies 42

Osteopathic 100

Other Procedures 60

Chiropractic 90

Imaging 2,934

Nuclear Medicine 463

Radiation Oncology 1,939

Rehabilitation and Diagnostic Audiology 1,380

Mental Health 30

Substance Abuse Treatment 59

Total 71,918

Number of Codes in ICD-10-PCS

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Seven Character Alphanumeric Code◦All procedure codes will be seven

characters long◦“I” and “O” (letters) are never used

Why not? 34 possible values for each character◦Digits 0 – 9◦Letters A-H, J-N, P-Z

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ICD-10-PCS: Code Structure

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• Medical and Surgical • Other Procedures• Obstetrics • Chiropractic• Placement • Imaging• Administration • Nuclear Medicine• Measurement and

Monitoring• Radiation Oncology

• Extracorporeal Assistance and Performance

• Physical Rehabilitation and Diagnostic Audiology

• Extracorporeal Therapies • Mental Health

• Osteopathic • Substance Abuse Treatment

System Structure16 Sections

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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

Building block concept!

ICD-10-PCS Tables

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Section: Identifies general type of procedureBody System: Identifies general body systemRoot Operation: Specifies objective of procedureBody Part: Identifies specific part of body system on

which procedure is being performedApproach: Technique used to reach the site of the

procedureDevice: Identifies devices that remain after procedure is

completedQualifier: Provides additional information about a

procedure, if necessary

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ICD-10-PCS Characters

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Provides the first three or four characters of the procedure code.

The tables must always be used to obtain the remaining digits for the complete code.

No eponyms are included. Tables are used to construct a complete and valid

code. Only characters appearing on the table may be

used.

ICD-10-PCS Index

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Medical and Surgical Section

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ICD-10-PCS Characters(Medical and Surgical Section)

Root

Section Operation Approach Qualifier

Body Body Device System Part

1 2 3 4 5 6 7

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1st character = Section 2nd character = Body System 3rd character = Root Operation 4th character = Body Part 5th character = Approach 6th character = Device 7th character = Qualifier

Susie Buys Root Beer At Dairy Queen

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The root operation is based on the “objective or intent” of the procedure not by the procedure name.

If multiple procedures as defined by distinct objectives are performed, then multiple ICD-10-PCS procedure codes are assigned.

Medical and Surgical Section Principles

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16 sections within ICD-10-PCS, the largest being the Medical & Surgical section.

Defines the general ‘type’ of procedure, i.e., Med/Surg, OB, etc.

Medical and Surgical Section the first character is always the number “0”.

Section Character (Character 1)

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Identifies the body system, which is the general physiological system or anatomical region where the procedure is performed.

Total of 31 body systems in ICD-10-PCS. Some traditional categories are subdivided into

several body systems, for example: Cardiovascular is subdivided into 5 body systems:

Heart and Great Vessels Upper Arteries Lower Arteries Upper Veins Lower Veins

Body System Character (Character 2)

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Refer to the ICD-10-PCS code book for a complete listing of the body systems (pg. 5).

Body Systems

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Defines the “objective” or “intent” of doing the procedure.

33 different root operation values Each root operation identifies a precise

and distinct objective.◦This is the most difficult part of procedural

coding as the root operations may sound familiar, but may mean different things.◦Most time will be spent here!

Root Operation Character (Character 3)

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The root operations ‘excision’ and ‘resection’ will be the most difficult to distinguish.◦Excision: Cutting out or off, without replacement a portion

of a body part◦Resection: Cutting out or off, without replacement, all of a

body part These definitions look very similar, but are very

different as they involve a portion versus all of a body part.

Where Will The Confusion Be?

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• Alteration • Fragmentation • Restriction

• Bypass • Excision • Release

• Change • Extirpation • Removal

• Control • Extraction • Repair

• Creation • Fragmentation • Replacement

• Destruction • Fusion • Reposition

• Detachment • Insertion • Resection

• Dilation • Inspection • Restriction

• Division • Map • Revision

• Drainage • Occlusion • Supplement

• Reattachment • Transfer

• Transplantation

Root Operations

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In ICD-10-PCS, every procedure falls into one of 33 root operations, which define the ‘objective’ of the procedure.

Some root operations seem self-explanatory, i.e., transplantation or reattachment, others are not so easy.◦ Procedure documentation may often include the term “removal”, but

according to PCS definitions the physician actually performed an extraction or even an extirpation, Do not code directly what the physician lists as the procedure; rather, you should always read the OP report to determine what the physician actually did and which definition the procedure meets.

Look at Procedures in a Whole New Way

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Procedure: Nonexcisional debridement of skin and back. There is no term in ICD-10-PCS for “debridement”, so based on definitions, the coder must review the body of the OP report to see what the physician actually performed. In this case, code the debridement as an extraction because it fits the definition (i.e., being pulled off a portion of the body part by use of force). In this case, skin is the body part.

Potential Documentation Problem

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The root operation is coded according to the objective of the procedure actually performed.

Discontinued or modified procedures coded to procedure actually performed.

Composite terms (i.e., colonoscopy, sigmoidectomy) are not root operations.

Combination procedures are coded separately◦Each procedure with a distinct objective during

an operative episode is coded separately.

Root Operation Principles

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The complete or partial redo of a procedure is coded to the root operation performed rather than “revision”.◦Revision is confined to correcting a malfunctioning or displaced device New for ICD-10

More Principles

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Procedures that take out or eliminate all or a portion of a body part Procedures that involve putting in or on, putting back, or moving

body parts Procedures that take out or eliminate solid matter, fluids, or gases

from a body part Procedures that only involve examination of body parts and regions Procedures that can be performed only on tubular body parts Procedures that always involve devices Procedures involving cutting or separation only Procedures involving other repairs Procedures with other objectives

Root Operation Groups

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Procedures that take out or eliminate all or a portion of a body part Excision Resection Extraction Destruction Detachment

Root Operations (1st Group)

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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

Excision

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Definition: Cutting out or off, without replacement, all of a body part

Examples: Total nephrectomy Total lobectomy of lung

Resection

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Definition: Pulling or stripping out or off all or a portion of a body part by the use of force

Explanation: The qualifier Diagnostic is used to identify extraction procedures that are biopsies

Examples: Dilatation and curettage Vein stripping

Extraction

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Definition: Physical eradication of all or a portion of a body part by the direct use of energy, force or a destructive agent

Explanation: None of the body part is physically taken out

Examples: Fulguration of rectal polyp Cautery of skin lesion

Destruction

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Definition: Cutting off all or part of the upper or lower extremities

Explanation: The body part value is the site of the detachment, with a qualifier if applicable, to further specify the level where the extremity was detached

Examples: Below knee amputation Disarticulation of shoulder

Detachment

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Procedures that involve putting in or on, putting back, or moving living body parts Transplantation Reattachment Reposition Transfer

Root Operations (2nd Group)

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Definition: 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

Explanation: The native body part may or may not be taken out, and the transplanted body part may take over all or a portion of its function

Examples: Kidney transplant Heart transplant

Transplantation

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Definition: Putting back in or on all or a portion of a separated body part to its normal location or other suitable location

Explanation: Vascular circulation and nervous pathways may or may not be reestablished

Examples: Reattachment of hand Reattachment of avulsed kidney

Reattachment

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Definition: Moving to its normal location or other suitable location all or a portion of a body part

Explanation: The body part is moved to a new location from an abnormal location, or from a normal location where it is not functioning correctly. The body part may or may not be cut out or off to be moved to the new location

Examples: Reposition of undescended testicles Fracture reduction

Reposition

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Definition: 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

Explanation: The body part transferred remains connected to its vascular and nervous supply

Examples: Tendon transfer Skin pedicle flap transfer

Transfer

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Procedures that take out or eliminate solid matter, fluids or gases from a body part

Drainage Extirpation (new term in ICD-10) Fragmentation

Root Operations (3rd Group)

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Definition: Taking or letting out fluids and/or gases from a body part

Explanation: The qualifier Diagnostic is used to identify drainage procedures that are biopsies

Examples: Thoracentesis Incision and drainage (I&D)

Drainage

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Definition: Taking or cutting out solid matter from a body part

Explanation: The solid matter may be an abnormal byproduct of a biological function or a foreign body. The solid matter is imbedded in a body part, or is in the lumen of a tubular body part. The solid matter may or may not have been previously broken into pieces. No appreciable amount of the body part is taken out

Examples: Thrombectomy Choledocholithotomy

Extirpation

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Definition: Breaking solid matter in a body part into pieces

Explanation: The solid matter may be an abnormal byproduct of a biological function or a foreign body. Physical force, i.e. manual, ultrasonic, applied directly or indirectly through intervening body parts is used to break the solid matter into pieces. The pieces of solid matter are not taken out, but are eliminated or absorbed through normal biological functions

Example: Extracorporeal shockwave lithotripsy

Fragmentation

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Procedures that only involve examination of body parts and regions Inspection Map

Root Operations (4th Group)

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Definition: Visually and/or manually exploring a body part

Explanation: Visual exploration may be performed with or without optical instrumentation. Manual exploration may be performed directly or through intervening body layers

Examples: Diagnostic arthroscopy Exploratory laparotomy

Inspection

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Definition: Locating the route of passage of electrical impulses and/or locating functional areas in a body part

Explanation: Applicable only to the cardiac conduction mechanism and the central nervous system

Examples: Cardiac mapping Cortical mapping

Map

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Procedures that can be performed only on tubular body parts Bypass Dilation Occlusion Restriction

Root Operations (5th Group)

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Definition: Altering the route of passage of the contents of a tubular body part

Explanation: Rerouting contents around an area of a body part to another distal (downstream) area in the normal route; rerouting the contents to another different but similar route and body part; or to an abnormal route and another dissimilar body part. It includes one or more concurrent anastomoses with or without the use of a device such as autografts, tissue substitutes and synthetic substitutes

Examples:◦Coronary artery bypass◦Colostomy formation

Bypass

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Definition: Expanding an orifice or the lumen of a tubular body part

Explanation: The orifice can be a natural orifice or an artificially created orifice. Accomplished by stretching a tubular body part using intraluminal pressure or by cutting part of the orifice or wall of the tubular body part

Examples: Percutaneous transluminal angioplasty Pyloromyotomy

Dilation

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Definition: Completely closing the orifice or lumen of a tubular body part

Explanation: The orifice can be a natural orifice or an artificially created orifice

Examples: Fallopian tube ligation Ligation of inferior vena cava

Occlusion

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Definition: Partially closing the orifice or lumen of a tubular body part

Explanation: The orifice can be a natural orifice or an artificially created orifice

Example: Esophagogastric fundoplication

Restriction

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Procedures that always involve devices Insertion Replacement Supplement Removal Change Revision

Root Operations (6th Group)

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Definition: 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

Examples: Insertion of radioactive implant Insertion of central venous catheter

Insertion

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Definition: 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

Explanation: The biological material is non-living, or the biological material is living and from the same individual. The body part may have been previously taken out, previously replaces, or may be taken out concomitantly with the replacement procedure. If the body part has been previously replaced, a separate Removal procedure is coded for taking out the device used in the previous replacement

Example: Total knee/hip replacement

Replacement

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Total Knee Replacement

in ICD-10-PCS

Right Knee Joint ReplacementICD-9-CM: 81.54 (Total Knee Replacement)

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0 S R D 0 J ZSection

(Medical/Surgical)Body System(Lower Joints)

Root Operation(Replacement)

Body Part(Knee Joint,

Right)

Approach(Open)

Device(Synthetic Substitute)

Qualifier(No

Qualifier)

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Definition: Putting in or on biological or synthetic material that physically reinforces or augments the function of a body part

Explanation: The biological material in non-living, or the material is living and from the same individual. The body part may have been previously replaced. If the body part has been previously replaced, the Supplement procedure is performed to physically reinforce and/or augment the function of the replaced body part

Examples: Herniorrhaphy using mesh New acetabular liner in a previous hip replacement

Supplement

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Definition: Taking out or off a device from a body part

Explanation: If the device is taken out and a similar device is put in without cutting or puncturing the skin or mucous membrane, the procedure is coded to the root operation Change. Otherwise, the procedure for taking out the device is coded to the root operation Removal and the procedure for putting in the new device is coded to the root operation as performed

Examples: Drainage tube removal Cardiac pacemaker removal

Removal

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Definition: 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

Explanation: All Change procedures are coded using the approach External

Examples: Urinary catheter change Gastrostomy tube change

Change

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Definition: Correcting, to the extent possible, a malfunctioning or displaced device

Explanation: Revision can include correcting a malfunctioning or displaced device by taking out or putting in components of the device such as a screw

Examples: Adjustment of pacemaker lead Adjustment of hip prosthesis

Revision

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Procedures involving cutting or separation only

DivisionRelease

Root Operations (7th Group)

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Definition: Cutting into a body part without draining fluids and/or gases from the body part in order to separate or transect a body part

Explanation: All or a portion of the body part is separated into two or more portions

Examples: Spinal cordotomy Osteotomy

Division

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Definition: Freeing a body part from an abnormal physical constraint by cutting or by use of force

Explanation: Some of the restraining tissue may be taken out but none of the body part is taken out

Examples: Adhesiolysis Carpal tunnel release

Release

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Procedures involving other repairsControlRepair

Root Operations (8th Group)

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Definition: Stopping, or attempting to stop, post-procedure bleeding

Explanation: The site of the bleeding is coded as an anatomical region and not to a specific body part

Examples: Control of post-prostatectomy hemorrhage Control of post-tonsillectomy hemorrhage

Control

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Definition: Restoring, to the extent possible, a body part to its normal anatomic structure and function

Explanation: Used only when the method to accomplish the repair is not one of the other root operation (used as ‘default’)

Examples: Herniorrhaphy Suture of laceration

Repair

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Procedures with other objectivesAlterationCreationFusion

Root Operations (9th Group)

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Definition: Modifying the anatomical structure of a body part without affecting the function of the body part

Explanation: Principal purpose is to improve appearance

Examples: Face lift Breast augmentation

Alteration

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Definition: Making a new genital structure that does not take over the function of a body part

Explanation: Used only for sex change operations

Examples: Creation of vagina in a male Creation of penis in a female

Creation

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Definition: Joining together portions of an articular body part rendering the articular body part immobile

Explanation: The body part is joined together by fixation device, bone graft, or other means

Examples: Spinal fusion Ankle arthrodesis

Fusion

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Identifies the body part or specific anatomical site where the physician performed a procedure

34 possible body part values in each body systemHepatobiliary

LiverLiver, Right Lobe Liver, Left Lobe GallbladderHepatic Duct, Right Hepatic Duct, Left

Body Part Character (Character 4)

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Indicates the technique the physician used to reach the site of the procedure.

Approaches may be through the skin or mucous membranes, through an orifice, or external.

ICD-10-PCS will have 7 different approach values.

Approach Character (Character 5)

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Approaches through the skin or mucous membrane

Open (Abdominal hysterectomy) Percutaneous (Needle biopsy of liver) Percutaneous Endoscopic (Arthroscopy)

Different Approaches…

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Approaches through an orifice Via Natural or Artificial Opening

(Endotracheal intubation) Via Natural or Artificial Opening Endoscopic

(Sigmoidoscopy) Via Natural or Artificial Opening Endoscopic

with Percutaneous Endoscopic Assistance (Lap-assisted vaginal hysterectomy)

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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

Example: Closed fracture reduction

Final Approach…External

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The term “device” includes only those devices that remain after the procedure is completed.

Instruments that describe how a procedure is performed are not specified in the device character.

Instruments for visualization are specified in the approach character, i.e., scope, etc.

Materials that are incidental to a procedure (i.e., clips, sutures) are not considered devices and would use device character “Z” to indicate “no device” in the ICD-10-PCS code.

Device Character (Character 6)

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Four (4) Categories Of Devices:◦Grafts and Prostheses◦ Implants◦Simple or Mechanical Appliances◦Electronic Appliance

Some of the devices used in musculoskeletal system procedures are internal and external fixation devices, bone growth stimulators, and drainage devices.

Device Values

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Biological or synthetic material that takes the place of all or a portion of a body part (i.e., skin graft, joint prosthesis).

Biological or synthetic material that assists or prevents a physiological function (i.e. urinary catheter, IUD).

Therapeutic material that is not absorbed by, eliminated by, or incorporated into a body part (i.e. radioactive implant, orthopedic pins). Therapeutic materials that are considered devices can be removed.

Device Categories

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Mechanical or electronic appliances used to assist, monitor, take the place of, or prevent a physiological function (i.e., diaphragmatic pacemaker, hearing device).

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Drainage Device Radioactive Element Autologous Tissue Substitute Extraluminal Device Intraluminal Device Synthetic Substitute Nonautologous Tissue Substitute

Examples of Device Values

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Defines an additional attribute of the procedure performed, if applicable.

May have a narrow application, to a specific root operation, body system, or body part.

Examples of Qualifiers◦Type of transplant◦Second site for a bypass◦Diagnostic excision (biopsy)

Last But Not Least… Qualifier!

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CHIEF COMPLAINT: Foreign body in nose.

HISTORY OF PRESENT ILLNESS: The patient is a 3-year-old child who comes in today after having put a raisin in her left nostril while playing at home. Grandmother was unable to remove it.

EMERGENCY DEPARTMENT COURSE: The raisin was grasped by bayonet forceps and removed atraumatically. Examination of the nostril fails to reveal any further foreign body or problems.

DIAGNOSIS: Foreign body in nostril with removal.

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Coding Example

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ICD-9-CM: 932 (Foreign body in nose)

ICD-10-CM: 2 options which contain more specific information about anatomic site and encounter.

T170xxA = Foreign body in nasal sinus, initial encounter

T171xxA = Foreign body in nostril, initial encounter

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Coding ExampleICD-10-CM (Diagnosis)

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ICD-9-CM: 98.12 (Removal of intraluminal foreign body from nose without incision)

ICD-10-PCS: Only 1 translation and/or coding option

◦09CKXZZ = Extirpation of matter from nose, external approach

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Coding ExampleICD-10-PCS (Procedure)

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That’s ICD-10-PCS!

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Let’s Practice What We Have Learned!

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www.ahima.org/icd10www.cdc.gov/nchs/about/otheract/icd9/abticd10.htmwww.cms.hhs.gov/ICD9ProviderDiagnosticCodes/08_ICD10.aspwww.cms.gov/ICD10www.who.int/classifications/icd/en

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Resources

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THANKS A TON!Day Egusquiza, [email protected]

Karen Kvarfordt, RHIA, CCS-P, CCDSAHIMA Certified ICD-10 Trainer President, DiagnosisPlus, [email protected]

www.arsystemsdayegusquiza.com

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