Understanding ICD-10-PCS (continued)
ICD-10-PCS Additional Characteristics
No Eponyms or Common Procedure Names
No Combination Codes
Standardized Level of Specificity
Diagnosis Information Excluded
NOS Code Options Restricted
Limited NEC Code Options
Procedures in the Medical and Surgical Section
Root Operation Groups
Procedures in the Medical and Surgical-related Sections
Measurement and Monitoring—Section 4
Extracorporeal Assistance and Performance—Section 5
Extracorporeal Therapies—Section 6
Other Procedures—Section 8
Procedures in the Ancillary Sections
Nuclear Medicine—Section C
Radiation Oncology—Section D
Physical Rehabilitation and Diagnostic Audiology—Section F
Mental Health—Section G
Substance Abuse Treatment—Section H
New Technology–Section X
General Coding Guidelines
ICD-10-PCS Coding - Important Points
Locating a Code in ICD-10-PCS
Step-By-Step Coding Examples
ICD-10-PCS Learning Activity
ICD-10-PCS Practice Questions
Standardized terminology within the coding system.
Standardized level of specificity.
No diagnostic information.
No explicit “not otherwise specified” (NOS) code options.
Limited use of “not elsewhere classified” (NEC) code options.
Standardized TerminologyWords commonly used in clinical vocabularies may have multiple meanings. This can cause confusion and result in inaccurate data. ICD-10-PCS is standardized and self-contained. Characters and values used in the system are defined in the system. For example, the word “excision” is used to describe a wide variety of surgical procedures. In ICD-10-PCS, the word “excision” describes a single, precise surgical objective, defined as “Cutting out or off, without replacement, a portion of a body part”.
As a result, ICD-10-PCS code descriptions do not include eponyms or common procedure names. Two examples from ICD-9-CM Volume 3 are 22.61, “Excision of lesion of maxillary sinus with Caldwell-Luc approach” and 51.10, “Endoscopic retrograde cholangiopancreatography [ERCP]”. In ICD-10-PCS, physicians’ names are not included in a code description, nor are procedures identified by common terms or acronyms such as appendectomy or CABG. Instead, such procedures are coded to the root operation that accurately identifies the objective of the procedure.
The procedures described in the preceding paragraph by ICD-9-CM Volume 3 codes are coded in ICD-10-PCS according to the root operation that matches the objective of the procedure. Here the ICD-10-PCS equivalents would be Excision and Inspection respectively. By relying on the universal objectives defined in root operations rather than eponyms or specific procedure titles that change or become obsolete, ICD-10-PCS preserves the capacity to define past, present, and future procedures accurately using stable terminology in the form of characters and values.
No Combination CodesWith rare exceptions, ICD-10-PCS does not define multiple procedures with one code. This is to preserve standardized terminology and consistency across the system. Procedures that are typically performed together but are distinct procedures may be defined by a single “combination code” in ICD-9-CM Volume 3. An example of a combination code in ICD-9-CM Volume 3 is 28.3, “Tonsillectomy with adenoidectomy”.
A procedure that meets the reporting criteria for a separate procedure is coded separately in ICD-10-PCS. This allows the system to respond to changes in technology and medical practice with the maximum degree of stability and flexibility.
The ICD-9-CM Volume 3 code 39.31, “Suture of artery” does not specify the artery, whereas the code range 38.40 through 38.49, “Resection of artery with replacement” provides a fourth-digit subclassification for specifying the artery by anatomical region (thoracic, abdominal, etc.).
In ICD-10-PCS, the codes identifying all artery suture and artery replacement procedures possess the same degree of specificity. The ICD-9-CM Volume 3 examples above coded to their ICD-10-PCS equivalents would use the same artery body part values in all codes identifying the respective procedures.
In general, ICD-10-PCS code descriptions are much more specific than their ICD-9-CM Volume 3 counterparts, but sometimes an ICD-10-PCS code description is actually less specific. In most cases this is because the ICD-9-CM Volume 3 code contains diagnosis information. The standardized level of code specificity in ICD-10-PCS cannot always take account of these fluctuations in ICD-9-CM Volume 3 level of specificity. Instead, ICD-10-PCS provides a standardized level of specificity that can be predicted across the system.
ICD-9-CM Volume 3 often contains information about the diagnosis in its procedure codes. Adding diagnosis information limits the flexibility and functionality of a procedure coding system. It has the effect of placing a code “off limits” because the diagnosis in the medical record does not match the diagnosis in the procedure code description. The code cannot be used even though the procedural part of the code description precisely matches the procedure performed.
Diagnosis information is not contained in any ICD-10-PCS code. The diagnosis codes, not the procedure codes, will specify the reason the procedure is performed.
In ICD-10-PCS, each character defines information about the procedure and all seven characters must contain a specific value obtained from a single row of a table to build a valid code. Even values such as the sixth-character value Z, No Device and the seventh-character value Z, No Qualifier, provide important information about the procedure performed.
Limited NEC Code OptionsICD-9-CM Volume 3 often designates codes as “not elsewhere classified” or “other specified” versions of a procedure throughout the code set. NEC options are also provided in ICD-10-PCS, but only for specific, limited use.
In the Medical and Surgical section, two significant “not elsewhere classified” options are the root operation value Q, Repair and the device value Y, Other Device.
The root operation Repair is a true NEC value. It is used only when the procedure performed is not one of the other root operations in the Medical and Surgical section.
Other Device, on the other hand, is intended to be used to temporarily define new devices that do not have a specific value assigned, until one can be added to the system. No categories of medical or surgical devices are permanently classified to Other Device.
For example, in the Medical and Surgical section, a body part value is always dependent for its meaning on the body system in which it is found. It cannot stand alone as a letter or a number and be meaningful. A fourth-character value of 6 by itself can mean 31 different things, but a fourth-character value of 6 in the context of a second-character value of D means one thing only - Stomach.
On the other hand, a root operation value is not dependent on any character but the section for its meaning, and identifies a single consistent objective wherever the third character is defined as root operation. For example, the third-character value T identifies the root operation Resection in both the Medical and Surgical and Obstetrics sections.
The approach value also identifies a single consistent approach wherever the fifth character is defined as approach. The fifth-character value 3 identifies the approach Percutaneous in the Medical and Surgical section, the Obstetrics section, the Administration section, and others.
The sixth-character device value or seventh-character qualifier value identifies the same device or qualifier in the context of the body system where it is found. Although there may be consistencies across body systems or within whole sections, this is not true in all cases.
Values in their designated context have a precise meaning, like words in a language. As seen in the code example which began this discussion, 0LB50ZZ represents the text description of the specific procedure “Excision of right lower arm and wrist tendon, open approach”. Since ICD-10-PCS values in context have a single, precise meaning, a complete, valid code can be read and understood without its accompanying text description, much like one would read a sentence.
Root operations that take out some or all of a body part - Five root operations representing procedures for taking out or otherwise eradicating some or all of a body part are listed in the table below.
Root operations that take out solids/fluids/gases from a body part - Three root operations representing procedures that take out solids, fluids, or gases from a body part are listed in the table below.
Root operations involving cutting or separation only - Two root operations representing procedures that cut or separate a body part are listed in the table below.
Root operations that put in/put back or move some/all of a body part - Four root operations representing procedures that put in, put back, or move some or all of a body part are listed in the table below.
Root operations that alter the diameter/route of a tubular body part - Four root operations representing procedures that alter the diameter or route of a tubular body part are listed in table below.
Root operations that always involve a device - Six root operations representing procedures that always involve a device are listed in the table below.
Root operations involving examination only - Two root operations representing procedures that involve examination of a body part are listed in the table below.
Root operations that define other repairs - Two root operations representing procedures that define other repairs are listed in the table below.
The root operation REPAIR represents a broad range of procedures for restoring the anatomic structure of a body part such as suture of lacerations. REPAIR also functions as the “not elsewhere classified (NEC)” root operation, to be used when the procedure performed does not meet the definition of one of the other root operations.
Root operations that define other objectives - Three root operations in the Medical and Surgical section, FUSION, ALTERATION, and CREATION, describe procedures performed for three distinct reasons. Beyond that they have little in common.
A FUSION procedure puts a dysfunctional joint out of service rather than restoring function to the joint.
ALTERATION encompasses a whole range of procedures that share only the fact that they are done to improve the way the patient looks.
CREATION represents only two very specific sex change operations.
Procedures in the Medical and Surgical-related sectionsNine additional sections of ICD-10-PCS include procedures related to the Medical and Surgical section are listed in the table below.
Administration—Section 3The ADMINISTRATION section includes infusions, injections, and transfusions, as well as other related procedures, such as irrigation and tattooing. All codes in this section define procedures where a diagnostic or therapeutic substance is given to the patient. Root operations in this section are classified according to the broad category of substance administered. If the substance given is a blood product or a cleansing substance, then the procedure is coded to TRANSFUSION and IRRIGATION respectively. All the other substances administered, such as anti-neoplastic substances, are coded to the root operation INTRODUCTION.
The fifth and sixth characters in this section define duration and function respectively. These characters describe the duration of the procedure and the body function being acted upon, rather than the approach and device used.
The root operations ASSISTANCE and PERFORMANCE are two variations of the same kinds of procedures, varying only in the degree of control exercised over the physiological function.
The second character contains a single general body system choice, PHYSIOLOGICAL SYSTEMS. The sixth character is defined as a qualifier, but contains no specific qualifier values. The seventh character qualifier identifies various blood components separated out in pheresis procedures.
The meaning of each root operation is consistent with the term as used in the medical community. DECOMPRESSION and HYPERTHERMIA have a more specialized meaning. All are defined in the table below.
The sixth-character methods such as LYMPHATIC PUMP and FASCIAL RELEASE are not explicitly defined in ICD-10-PCS, and rely on the standard definitions as used in this specialty.
There are relatively few procedure codes in this section, for nontraditional, whole body therapies including acupuncture and meditation. There is also a code for the fertilization portion of an in-vitro fertilization procedure.
Codes in these sections contain characters not previously defined, such as Contrast, Modality Qualifier and Equipment.
Third character defines procedure by root type, instead of root operation.
Fifth character defines contrast if used.
Sixth character is a qualifier that specifies an image taken without contrast followed by one with contrast.
Seventh character is a qualifier that is not specified in this section.
The IMAGING root types are defined in the following table:
The third character classifies the procedure by root type instead of by root operation.
The fifth character specifies the radionuclide, the radiation source used in the procedure. Choices are applicable for the root procedure type.
The sixth and seventh characters are qualifiers, and are not specified in this section.
Third character defines root type, which is the basic modality.
Fifth character further specifies treatment modality.
Sixth character defines the radioactive isotope used, if applicable.
Seventh character is a qualifier, and is not specified in this section.
The third character defines the treatment modality as root type. Examples are BRACHYTHERAPY and STEREOTACTIC RADIOSURGERY. Four different root types are used in this section, as listed in the table below.
Physical Rehabilitation and Diagnostic Audiology—Section FPHYSICAL REHABILITATION AND DIAGNOSTIC AUDIOLOGY contains character definitions unlike the other sections in ICD-10-PCS. They are described below.
Second character is a section qualifier that specifies whether the procedure is a rehabilitation or diagnostic audiology procedure.
Third character defines the general procedure root type.
Fourth character defines the body system and body region combined, where applicable.
Fifth character further specifies the procedure type.
Sixth character specifies the equipment used, if any.
This section uses the third character to classify procedures into 14 root types. They are defined in the table below.
Third character describes the mental health procedure root type.
Fourth character further specifies the procedure type as needed.
Second, fifth, sixth, and seventh characters do not convey specific information about the procedure. The value Z functions as a placeholder in these characters.
The third character describes the mental health root type. There are 11 root type values in this section, as listed in the table below.
Third character describes the root type.
Fourth character is a qualifier that further classifies the root type.
Second, fifth, sixth, and seventh characters do not convey specific information about the procedure. The value Z functions as a placeholder in these characters.
There are seven different root type values classified in this section, as listed in the following table.
ICD-10-PCS codes are composed of seven characters. Each character is an axis of classification that specifies information about the procedure performed. Within a defined code range, a character specifies the same type of information in that axis of classification.
Example: The fifth axis of classification specifies the approach in sections 0 through 4 and 7 through 9 of the system.
One of 34 possible values can be assigned to each axis of classification in the seven-character code: they are the numbers 0 through 9 and the alphabet (except I and O because they are easily confused with the numbers 1 and 0). The number of unique values used in an axis of classification differs as needed.
Example: Where the fifth axis of classification specifies the approach, seven different approach values are currently used to specify the approach.
The valid values for an axis of classification can be added to as needed.
Example: If a significantly distinct type of device is used in a new procedure, a new device value can be added to the system.
As with words in their context, the meaning of any single value is a combination of its axis of classification and any preceding values on which it may be dependent.
Example: The meaning of a body part value in the Medical and Surgical section is always dependent on the body system value. The body part value 0 in the Central Nervous body system specifies Brain and the body part value 0 in the Peripheral Nervous body system specifies Cervical Plexus.
As the system is expanded to become increasingly detailed, over time more values will depend on preceding values for their meaning.
Example: In the Lower Joints body system, the device value 3 in the root operation Insertion specifies Infusion Device and the device value 3 in the root operation Fusion specifies Interbody Fusion Device.
The purpose of the alphabetic index is to locate the appropriate table that contains all information necessary to construct a procedure code. The ICD-10-PCS Tables should always be consulted to find the most appropriate valid code.
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.
All seven characters must be specified to be a valid code. If the documentation is incomplete for coding purposes, the physician should be queried for the necessary information.
Within an ICD-10-PCS table, valid codes include all combinations of choices in characters 4 through 7 contained in the same row of the table.
“And” when used in a code description, means “and/or”.
Example: Lower Arm and Wrist Muscle means lower arm and/or wrist muscle.
Many of the terms used to construct ICD-10-PCS codes are defined within the system. It is the coder’s responsibility to determine what the documentation in the medical record equates to in the ICD-10-PCS definitions. The physician is not expected to use the terms used in ICD-10-PCS code descriptions, nor is the coder required to query the physician when the correlation between the documentation and the defined ICD-10-PCS terms is clear.
Example: When the physician documents “partial resection” the coder can independently correlate “partial resection” to the root operation Excision without querying the physician for clarification.
ICD-10-PCS Coding - Important PointsThe ability of the coder to build the correct ICD-10-PCS code requires a greater knowledge of anatomy and physiology than under ICD-9-CM Volume 3. Furthermore, coders will continue to be dependent on physician documentation included in the operative or procedure reports.
ICD-10-PCS is used for facility reporting of hospital inpatient procedures and does NOT affect the use of CPT.
Identify the main term(s) in the operative or procedure report, then reference in the Index.
Review any subterms under the main term in the Index.
Follow any cross-reference instructions, such as –see, –see also.
Verify the code(s) selected from the Index in the Root Operation Tables.
All ICD-10-PCS codes consist of seven characters.
See the full text description for an ICD-10-PCS code in the List of Codes.
Example 1: Excision of chalazion from the left upper eyelid.
Example 2: Reattachment of right upper arm.
Example 3: Heart catheterization with cardiac mapping.
Example 4: Arthroscopy with drainage of hemarthrosis at previous operative site, right knee.
Example 5: Laparotomy with drain placement for liver abscess, right lobe.
Example 6: Replantation of avulsed scalp.
Example 7: Removal of packing material from pharynx.
Example 8: External electrocardiogram (EKG), single reading.
Example 9: Ultraviolet light phototherapy, series treatment.
Example 10: X-ray of right clavicle, limited study.
• This activity will help assess your understanding of Root Operations and Approaches found in the ICD-10-PCS.
(Click Check Answer: to reveal answer).
What is the root operation for post-prostatectomy bleeding?
Answer: Control is the root operation for post-prostatectomy bleeding.
What is the root operation for thrombectomy?
Answer: Extirpation is the root operation for thrombectomy.
What is the root operation for herniorrhaphy?
Answer: Repair is the root operation for herniorrhaphy.
Which approach is defined by 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?
Answer: External approach.
Which approach is defined by entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedure?
Answer: Percutaneous endoscopic.
Which approach is defined by entry, by puncture or minor incision, through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure?
ICD-10-PCS Practice Question #1
Which of the following key differences between ICD-9-CM Volume 3 and ICD-10-PCS is INCORRECT?
- a) ICD-9 Volume 3 follows ICD structure (designed for diagnosis coding). ICD-10-PCS designed/developed to meet healthcare needs for a procedure code system.
- b) ICD-9 Volume 3 codes available as a fixed/finite set in list form. ICD-10-PCS codes constructed from flexible code components (values) using tables.
- c) ICD-9-Volume 3 codes are numeric. ICD-10-PCS codes are alphanumeric.
- d) ICD-9 Volume 3 codes are 3 to 4 digits long. ICD-10-PCS codes are five to seven characters long.
Answer: d) All ICD-10-PCS codes are seven characters long. The other statements are all TRUE.
ICD-10-PCS Practice Question #2
A key feature of ICD-10-PCS is that information pertaining to a diagnosis is included from the code descriptions.
Answer: False. A key feature of ICD-10-PCS is that information pertaining to a diagnosis is excluded from the code descriptions.
ICD-10-PCS Practice Question #3
Which of the following is the first character/component of an ICD-10-PCS code?
- a) Root Operation
- b) Body System
- c) Section
- d) Approach
Answer: c) The section value is the first character/component of an ICD-10-PCS code; root operation is the third character/component; body system is the second character/component; approach is the fifth character/component of an ICD-10-PCS code.
ICD-10-PCS Practice Question #4
Imaging procedures, nuclear medicine, radiation oncology, physical rehab, diagnostic audiology, mental health and substance abuse treatment are collectively grouped into which section?
- a) Ancillary section
- b) Auxillary section
- c) Other procedures section
- d) Qualifiers section
Answer: a) The procedures are collectively grouped into Ancillary Section.
ICD-10-PCS Practice Question #5
What is the objective of root operation Destruction?
- a) Breaking solid matter into pieces.
- b) Cutting out/off without replacement.
- c) Eradicating without replacement.
- d) Pulling out or off without replacement.
Answer: c) Eradicating without replacement is the objective of root operation Destruction. Breaking solid matter into pieces - the objective of root operation Fragmentation. Cutting out/off without replacement - this objective pertains to Excision, Resection and Detachment. Pulling out or off without replacement – the objective of root operation Extraction.
** Use the Index and Tables in your ICD10 PCSLink Database (or ICD-10-PCS Manual) to answer the next 3 questions **
ICD-10-PCS Practice Question #6
Which code is reported for Bypass Spinal Canal to Urinary Tract with Autologous Tissue Substitute, Percutaneous Approach?
- a) 00160J7
- b) 00163J7
- c) 00160J7
- d) 001U377
Answer: d) Code 001U377 is Bypass Spinal Canal to Urinary Tract with Autologous Tissue Substitute, Percutaneous Approach. Code 00160J7 is Bypass Cerebral Ventricle to Urinary Tract with Synthetic Substitute, Open Approach. Code 00163J7 is Bypass Cerebral Ventricle to Urinary Tract with Synthetic Substitute, Percutaneous Approach. Code 00160J7 is Bypass Cerebral Ventricle to Urinary Tract with Synthetic Substitute, Open Approach.
ICD-10-PCS Practice Question #7
Which code is reported for Excision of Right External Iliac Artery, Percutaneous Endoscopic Approach, Diagnostic?
- a) 04BF4ZX
- b) 04BH4ZX
- c) 0410094
- d) 06BG4ZX
Answer: b) Code 04BH4ZX is Excision of Right External Iliac Artery, Percutaneous Endoscopic Approach, Diagnostic. Code 04BF4ZX is Excision of Left Internal Iliac Artery, Percutaneous Endoscopic Approach, Diagnostic. Code 0410094 is Bypass Abdominal Aorta to Left Renal Artery with Autologous Venous Tissue, Open Approach. Code 06BG4ZX is Excision of Left External Iliac Vein, Percutaneous Endoscopic Approach, Diagnostic.
ICD-10-PCS Practice Question #8
Which code is reported for Fluoroscopy of Right Tracheobronchial Tree using Other Contrast?
- a) BB27YZZ
- b) DB002ZZ
- c) BB09YZZ
- d) BB17YZZ
Answer: d) BB17YZZ is Fluoroscopy of Right Tracheobronchial Tree using Other Contrast. Code BB27YZZ is Computerized Tomography (CT Scan) of Right Tracheobronchial Tree using Other Contrast. Code BB09YZZ is Plain Radiography of Bilateral Tracheobronchial Trees using Other Contrast.
Use the Index and Tables in your ICD10 PCSLink Database (or ICD-10-PCS Manual) to answer the next 2 questions
ICD-10-PCS Practice Question #9
Using the table above, which of the following is not a valid code?
- a) 0JHW3VZ
- b) 0JHW01Z
- c) 0JHS33Z
- d) 0JHT3VZ
ICD-10-PCS Practice Question #10
Using the table above, which of the following is the code for Respiratory Ventilation, Less than 24 Consecutive Hours?
- a) 5A15223
- b) 5A19054
- c) 5A1935Z
- d) 5A1945Z
Answer: c) Code 5A1935Z is Respiratory Ventilation, Less than 24 Consecutive Hours. Code 5A15223 is Extracorporeal Membrane Oxygenation, Continuous. Code 5A19054 is Respiratory Ventilation, Single, Nonmechanical. Code 5A1945Z is Respiratory Ventilation, 24-96 Consecutive Hours.