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. • Tip! Refer to Appendix F: Character Meanings – this will save you! • But don’t panic, it can be easily mastered!
More Tips… • 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.
And The Best Tip! • 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!
Who Developed The ICD-10-PCS System? • 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?
General Principles • 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“Limited NOS” Option • 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?
Limited NOS Option • 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.
ICD-9-CM vs. ICD-10-PCS • ICD-10-PCS (Procedures) • Min. characters: 7 • Max. characters: 7 • Alphanumeric format • No decimal point • 71,918 procedure codes • 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: Code Structure • 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
ICD-10-PCS Tables • 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 Characters Section: Identifies general type of procedure Body System: Identifies general body system Root Operation: Specifies objective of procedure Body Part: Identifies specific part of body system on which procedure is being performed Approach: Technique used to reach the site of the procedure Device: Identifies devices that remain after procedure is completed Qualifier: Provides additional information about a procedure, if necessary
ICD-10-PCS Index • 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 Characters(Medical and Surgical Section) Root SectionOperationApproachQualifier BodyBodyDevice System Part
Susie Buys Root Beer AtDairy Queen • 1st character = Section • 2nd character = Body System • 3rd character = Root Operation • 4th character = Body Part • 5th character = Approach • 6th character = Device • 7th character = Qualifier
Medical and Surgical Section Principles • 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.
Section Character (Character 1) • 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”.
Body System Character (Character 2) • 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 Systems • Refer to the ICD-10-PCS code book for a complete listing of the body systems (pg. 5).
Root Operation Character (Character 3) • 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!
Where Will The Confusion Be? • 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.
Look at Procedures in a Whole New Way • 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.
Potential Documentation Problem 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.
Root Operation Principles • 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.
More Principles • 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
Root Operation Groups • 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 Operations (1st Group) • Procedures that take out or eliminate all or a portion of a body part • Excision • Resection • Extraction • Destruction • Detachment
Excision • 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
Resection • Definition: Cutting out or off, without replacement, all of a body part • Examples: • Total nephrectomy • Total lobectomy of lung
Extraction • 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
Destruction • 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
Detachment • 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
Root Operations (2nd Group) • Procedures that involve putting in or on, putting back, or moving living body parts • Transplantation • Reattachment • Reposition • Transfer
Transplantation • 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
Reattachment • 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
Reposition • 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
Transfer • 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
Root Operations (3rd Group) • Procedures that take out or eliminate solid matter, fluids or gases from a body part • Drainage • Extirpation (new term in ICD-10) • Fragmentation
Drainage • 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)
Extirpation • 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
Fragmentation • 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
Root Operations (4th Group) • Procedures that only involve examination of body parts and regions • Inspection • Map
Inspection • 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
Map • 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