ICD-10-PCS QUICK REFERENCE GUIDE
Since 1979, in the United States the reporting of hospital inpatient procedures has been done using Volume 3 of the International Classification of Diseases, Ninth Revision, Clinical
Modification (ICD-9-CM). For discharges on and after October 1, 2014, the International Classification of Diseases, Tenth Revision, Procedural Coding System (ICD-10-PCS) will be
implemented in the United States. On October 1, 2014, hospitals will continue to use CPT/HCPCS codes for outpatient services, while physicians will continue to use CPT/HCPCS
codes for all medical services that they render (regardless of the location).
CODE STRUCTURE

All codes contain 7 alphanumeric characters, for example:
5A1221Z
Cardiopulmonary bypass (heart-lung machine)
10H073Z
Fetal pulse oximetry
8E0ZXY1
HZ2ZZZZ
In vitro fertilization
Detoxification services for substance abuse
5A1D00Z
0XMJ0ZZ
Hemodialysis
Reattachment right hand

No use of a decimal

A code is derived by choosing a specific value for each of the 7 characters - one of 34 possible values can be assigned to each character in a code: the numbers 0 through 9 and
the alphabet (except letters I and O, because they are easily confused with the numbers 1 and 0).

The same value placed in a different position in the code means something different (e.g., the value A in the first character means something different than A in the second
character, or A in the third character, and so on).

Each character in the seven-character code represents an aspect of the procedure, as shown in the following diagram. The code 0SR9029 below is used to classify a
procedure titled “right total hip arthroplasty using a cemented stem and a metal on polyethylene articulating surface.” The acetabular component of the hip was
replaced by a cup made of a very durable plastic material called polyethylene; the femoral head of the thigh bone was replaced by a metal ball attached to a stem. Cement was
used to secure the stem into the thigh bone.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
0
S
R
9
0
2
9
Character 1: Section - The first character in the code determines the broad procedure category, or section, where the code is found. In this example, the section is Medical
and Surgical - 0 is the value that represents Medical and Surgical in the first character.
There are a total of 16 sections in ICD-10-PCS: Medical and surgical/ Obstetrics/ Placement/ Administration/ Measurement and monitoring/ Extracorporeal assistance and
performance/ Extracorporeal therapies/ Osteopathic/ Other procedures/ Chiropractic/ Imaging /Nuclear medicine/ Radiation oncology/ Physical rehabilitation and
diagnostic audiology/ Mental health/ Substance abuse treatment
Character 2: Body System - The second character defines the body system—the general physiological system or anatomical region involved. In this example, the anatomical
region is Lower Joints - S is the value that represents Lower Joints in the second character of the Medical and Surgical section.
Character 3: Root Operation - The third character defines the root operation, or the objective of the procedure. In this example, the root operation is Replacement - R is the
value that represents Replacement in the third character of the Medical and Surgical section.
There are a total of 31 root operations in the Medical and Surgical section: Alteration/ Bypass/ Change/ Control/ Creation/ Destruction/ Detachment/ Dilation/ Division/
Drainage/ Excision/ Extirpation/ Extraction/ Fragmentation/ Fusion/ Insertion/ Inspection/ Map/ Occlusion/ Reattachment/ Release/ Removal/ Repair/ Replacement/
Reposition/ Resection/ Restriction/ Revision/ Supplement/ Transfer/ Transplantation
Character 4: Body Part - The fourth character defines the body part, or specific anatomical site where the procedure was performed. In this example, the body part is Hip
Joint, Right - 9 is the value that represents Hip Joint, Right in the fourth character of the Medical and Surgical section. Tip: ICD-10-PCS also contains an appendix titled Body
Part Key that provides more details about the selection of a body part value.
Character 5: Approach - The fifth character defines the approach, or the technique used to reach the procedure site. In this
example, the approach is Open - 0 is the value that represents Open in the fifth character of the Medical and Surgical section.
Character 6: Device - Depending on the procedure performed, there may or may not be a device left in place at the end
of the procedure. The sixth character defines the device. Device values fall into four basic categories: grafts and
prostheses, implants, simple or mechanical appliances and electronic appliances. In this example, 2 is the value that
represents the device Synthetic Substitute, Metal on Polyethylene. Tip: ICD-10-PCS also contains an appendix titled
Device Key that provides more details about the selection of a device value.
Character 7: Qualifier - The seventh character defines a qualifier for the code. A qualifier specifies an additional attribute
of the procedure, if applicable. In this example, 9 is the value that represents the qualifier for Cemented.
ICD-10-PCS QUICK REFERENCE GUIDE
The ICD-10-PCS alphabetic index is used to access multiple root operation tables. The
root operation tables provide the valid choices of values available to construct a seven
character ICD-10-PCS code. The values for characters 1 through 3 are located at the
top of each root operation table; and the table also contains four columns and a varying
number of rows with each row specifying the valid choices for the characters 4 through
7.
The ICD-10-PCS alphabetic index generally only provides the first 3-4 characters of the
code with the first three characters indicating the correct root operation table to
reference. An ICD-10-PCS coding example is provided.
Procedure to be coded: *Right total hip arthroplasty using a cemented stem and a
metal on polyethylene articulating surface.* Final correct ICD-10-PCS code: 0SR9029
ICD-10-PCS Index Excerpt
Replacement
Hip
Left 0SRB
Acetabular Surface 0SRE
Femoral Surface 0SRS
Right 0SR9  This is the appropriate subterm based on the procedure to be coded.
Acetabular Surface 0SRA
Femoral Surface 0SRR
ICD-10-PCS Root Operation Table “0SR”
Medical and surgical
Lower Joints
Replacement: 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
Body Part
Approach
Device
Qualifier
0 Lumbar Vertebral Joint
2 Lumbar Vertebral Disc
3 Lumbosacral Joint
4 Lumbosacral Disc
5 Sacrococcygeal Joint
6 Coccygeal Joint
7 Autologous Tissue Substitute
7 Sacroiliac Joint, Right
0 Open
J Synthetic Substitute
Z No Qualifier
8 Sacroiliac Joint, Left
K Nonautologous Tissue Substitute
H Tarsal Joint, Right
J Tarsal Joint, Left
K Metatarsal-Tarsal Joint, Right
L Metatarsal-Tarsal Joint, Left
M Metatarsal-Phalangeal Joint, Right
N Metatarsal-Phalangeal Joint, Left
P Toe Phalangeal Joint, Right
Q Toe Phalangeal Joint, Left
1 Synthetic Substitute, Metal
9 Hip Joint, Right
2 Synthetic Substitute, Metal on Polyethylene
9 Cemented
B Hip Joint, Left
3 Synthetic Substitute, Ceramic
A Uncemented
0 Open
4 Synthetic Substitute, Ceramic on Polyethylene
Z No Qualifier
J Synthetic Substitute
Section
Body System
Operation
0
S
R
9 Hip Joint, Right
B Hip Joint, Left
0 Open
A Hip Joint, Acetabular Surface, Right
E Hip Joint, Acetabular Surface, Left
0 Open
A Hip Joint, Acetabular Surface, Right
E Hip Joint, Acetabular Surface, Left
0 Open
7 Autologous Tissue Substitute
K Nonautologous Tissue Substitute
0
1
3
J
7
K
Synthetic Substitute, Polyethylene
Synthetic Substitute, Metal
Synthetic Substitute, Ceramic
Synthetic Substitute
Autologous Tissue Substitute
Nonautologous Tissue Substitute
Z No Qualifier
9 Cemented
A Uncemented
Z No Qualifier
Z No Qualifier
ICD-10 RESOURCES: http://www.cms.gov/icd10; http://www.cms.gov/ICD10/Tel10/list.asp;
http://www.cms.gov/ICD10/06_MedicareFeeforServiceProviderResources.asp; http://www.cms.gov/ICD10/05a_ProviderResources.asp; http://www.wedi.org;
http://www.himss.org/icd10
Lolita M. Jones Consulting Services * www.EZMedEd.com * July 2012