Crossing the
Bridge
Preparing for
ICD-10-PCS
Crystal Clack, MS, RHIA, CCS
AHIMA Approved ICD-10-CM/PCS Trainer
OrHIMA Fall Conference 2013
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
A Brief History
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
ICD-9-CM Vol. 3 vs ICD-10-PCS
ICD-9-CM Volume 3
ICD-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 numeric
Codes are alphanumeric
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.
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!
ICD-10-PCS Format & Structure
Character
Character
Character
Character
Character
Character
Character
1
2
3
4
5
6
7
Section
Body
System
Root
Operation
Body
Part
Approach
Device
Qualifier
• 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
Section ~ Character 1
Character
Character
Character
Character
Character
Character
Character
1
2
3
4
5
6
7
Section
Body
System
Root
Operation
Body
Part
Approach
Device
Qualifier
• 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
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.
Sections of ICD-10-PCS as follows:
Value
Section
Value
Section
0
Medical & Surgical
9
Chiropractic
1
Obstetrics
B
Imaging
2
Placement
C
Nuclear Med
3
Administration
D
Radiation Tx
4
Measuring & Monitoring
F
Physical Rehab &
Diagnostic Audiology
5
Extracorporeal
Assistance &
Performance
G
Mental Health
6
Extracorporeal Therapies
H
Substance Abuse
Treatment
7
Osteopathic
8
Other Procedures
BOLD italics = Ancillary
Body System~ Character 2
Character
Character
Character
Character
Character
Character
Character
1
2
3
4
5
6
7
Section
Body
System
Root
Operation
Body
Part
Approach
Device
Qualifier
• Second character
• Body System, general physiological system or anatomical
region involved
• Review Body Systems in training manual
• Appendix G
Body System
0 - Central Nervous Sys.
C – Mouth & Throat
Q – Lower Bones
1 – Peripheral Nervous Sys
D – Gastro System
R – Upper Joints
2 – Heart & Great Vessels
F – Hepatobiliary System
& Pancreas
S – Lower Joints
3 – Upper Arteries
G – Endocrine System
T – Urinary System
4 – Lower Arteries
H – Skin & Breast
U – Female Reproductive
System
5 – Upper Veins
J – SQ Tissue & Fascia
V – Male Reproductive
System
6 – Lower Veins
K – Muscles
W – Anatomical Regions,
General
7 – Lymphatic & Hemic
L - Tendons
X – Anatomical Regions,
Upper Extremities
8 – Eye
M – Bursae & Ligaments
Y – Anatomical Regions,
Lower Extremities
9 – Ear Nose & Sinus
N – Head & Facial Bones
B – Respiratory System
P – Upper Bones
Root Operations ~ Character 3
Character
Character
Character
Character
Character
Character
Character
1
2
3
4
5
6
7
Section
Body
System
Root
Operation
Body
Part
Approach
Device
Qualifier
• Objective of Procedure
• 31 root operations
• Arranged by similar attributes
• Multiple codes
Examples of Root Operations
 Bypass
 Drainage
 Reattachment
 Resection
 Inspection
Root Operations
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
There are 31 different root operations! The root is the
reason, or objective, for the procedure
Body Part ~ Character 4
Character
Character
Character
Character
Character
Character
Character
1
2
3
4
5
6
7
Section
Body
System
Root
Operation
Body
Part
Approach
Device
Qualifier
• Fourth character
• Anatomical site for procedure
• 34 possible values per body system
Examples of Body Parts
 Liver
 Kidney
 Axillary
 Thalamus
 Radial
 Ascending
 Optic
 Tonsil
Colon
Nerve
vein, left
nerve
 Cerebellum
 Upper
lung lobe (R)
Approach ~ Character 5
Character
Character
Character
Character
Character
Character
Character
1
2
3
4
5
6
7
Section
Body
System
Root
Operation
Body
Part
Approach
Device
Qualifier
• Fifth character – approach or technique used to reach
procedure
• Seven different approach values
• May be through: skin, mucous membrane, orifice or
external
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
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
Device ~ Character 6
Character
Character
Character
Character
Character
Character
Character
1
2
3
4
5
6
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.
Four Groups of Devices

Grafts

Prostheses

Implants

Simple or Mechanical Appliances

Electronic Appliances
Qualifier ~ Character 7
Character
Character
Character
Character
Character
Character
Character
1
2
3
4
5
6
7
Section
Body
System
Root
Operation
Body
Part
Approach
Device
Qualifier
• Provides additional information
• May have narrow application
• There are NO specific guidelines for qualifiers
TIP!
Most procedures will not have an
applicable qualifier…the default value to
indicate that NO qualifier
is necessary is……
Z
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
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
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
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.
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.
B3. Root Operation - General guidelines continued:
B3.2.
Multiple Procedures:
During the same operative episode, multiple procedures are
coded if:
a.
b.
c.
d.
The same root operation is performed on
different body parts as defined by distinct
values of the body part character.
The same root operation is repeated at
different body sites that are included in the
same body part value.
Multiple root operations with distinct
objectives are performed on the same body part
The intended root operation is attempted using one
approach, but it converted to a different approach
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
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
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:
_________________________________
Example Case One Snapshot of PCS Coding Book
Answer Case One
What is the ICD-10-PCS code for this procedure?
Root operation:
Excision
Specific Body Part:
Duodenum identified with 4th character
Seventh Character:
“X” for diagnostic
ICD-10-PCS Code:
0DB98ZX
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
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:
_________________________________
Example Case Two Snapshot of PCS Coding Book
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
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.
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.
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:
_________________________________
Example Case Three Snapshot of PCS Coding Book
Answer Case Three
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
DO WE HAVE TO CLIMB THAT?!
Preparing for the
Inevitable:
10/01/2014
Don’t be a Fish out of Water!
 Brush up on your anatomy
 Review your pathophysiology
 Don’t procrastinate!
 START NOW
Many, Many Web Resources!
1. http://www.ahima.org/icd10/
2. http://www.aapc.com/icd-10/
3. http://www.cms.gov/Medicare/Coding/ICD10/index.html?redire
ct=/icd10
4. http://www.himss.org/library/icd-10/playbook?navItemNumber=13480
5. http://health-information.advanceweb.com/ICD-10-ResourceCenter/default.aspx
6. www.fortherecordmag.com
Resources Used

Application of ICD-10-PCS Root Operations, Audio Seminar, October 23, 2012
AHIMA

ICD-10-CM Official Guidelines for Coding and Reporting 2014:
http://www.cdc.gov/nchs/data/icd9/icd10cm_guidelines_2014.pdf

ICD-10-PCS Code Set: http://www.cdc.gov/nchs/icd/icd10cm.htm/

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
Summer, 2015…..Life is Good!