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Introducing ICD-10-PCS Approaches. Presented by: THIMA ICD 10 Committee . APPROACHES. The fifth character of ICD-10-PCS codes represents the approach or technique that is used to reach the procedure site. 7 different approaches in the Medical and Surgical Section. 7 Approaches. Open

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Introducing ICD-10-PCS Approaches


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    1. Introducing ICD-10-PCS Approaches Presented by: THIMA ICD 10 Committee

    2. APPROACHES The fifth character of ICD-10-PCS codes represents the approach or technique that is used to reach the procedure site. 7 different approaches in the Medical and Surgical Section

    3. 7 Approaches Open Percutaneous Percutaneous Endoscopic Via Natural or Artificial Opening Via Natural or Artificial Opening, Endoscopic Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance External

    4. Approaches Table d 4

    5. Approaches Table, cont. d 5

    6. Approach - Open Cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure.

    7. Approach Guidelines B5.2 Procedures performed using the open approach with percutaneous endoscopic assistance are coded to approach value 0, open.

    8. Approach - Open The access location would be skin or mucous membranes No instrumentation used Example: Abdominal Hysterectomy

    9. Approach - Percutaneous Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure.

    10. Approach guideline • B5.4 Procedures performed percutaneously via a device placed for the procedure are coded to the approach Percutaneous • Example: Fragmentation of kidney stone performed via percutaneousnephrostomy is coded to the approach Percutaneous

    11. Approach - Percutaneous The access location would be skin or mucous membrane Instrumentation without visualization EXAMPLE: Needle biopsy of liver

    12. Approach – Percutaneous Endoscopic 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.

    13. Approach - Percutaneous Endoscopic Access location is skin or mucous membran Instrumentation with visualization

    14. Approach – Via Natural or Artificial Opening Entry of instrumentation through a natural or artificial external opening to reach the site of the procedure.

    15. Approach – Via Natural or Artificial Opening Access location is Orifice Instrumentation without visualization Example: Insertion of Endotracheal Tube

    16. Approach – Via Natural or Artificial Opening, Endoscopic Entry of instrumentation through a natural or artificial external opening to reach and visualize the site of the procedure.

    17. Approach – Via Natural or Artificial Opening, Endoscopic Instrumentation is withvisualization Access location is Orifice Example: Sigmoidoscopy

    18. Approach – Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance Entry of instrumentation through a natural or artificial external opening and entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to aid in the performance of the procedure.

    19. Approach – Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance Access location is skin or mucous membrane. Instrumentation is with visualization. Example: Laparoscopic-assisted vaginal hysterectomy

    20. Approach - External 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.

    21. Approaches - External Access location is skin or mucous membranes No specified instrumentation Example: Closed reduction of fracture

    22. Approach - Guidelines B5.3a Procedures performed within an orifice on structures that are visible without the aid of any instrumentation are coded to approach External. Example: Resection of tonsils

    23. Approach Guidelines, cont. B5.3b Procedures performed indirectly by the application of external force through the intervening body layers are coded to the approach External. Example: Closed reduction of fracture

    24. Let’s practice what we’ve just learned.

    25. Resection of Tonsils – Approach? External

    26. Endoscopic Drainage of Sinuses –Approach? Percutaneous Endoscopic

    27. Cautery of Nosebleed – Approach? External

    28. Transurethral Cystoscopy with Removal of Bladder Stone – Approach? Via Natural or Artificial Opening, Endoscopic

    29. Open Cholecystectomy – Approach? • Open

    30. Laparoscopic Cholecystectomy – Approach? Percutaneous Endoscopic

    31. CABG – Approach? Open

    32. Colonoscopy – Approach? Via Natural or Artificial Opening, Endoscopic

    33. Open Endarterectomy – Approach? Open

    34. Endotracheal Intubation – Approach? Via Natural or Artificial Opening

    35. Excision Of Skin Lesion – Approach? External

    36. Percutaneous Drainage of Ascites – Approach? Percutaneous

    37. Low Anterior Resection, Colon – Approach? Open

    38. Bronchoscopy – Approach? Via Natural or Artificial Opening, Endoscopic

    39. ERCP – Approach? Via Natural or Artificial Opening, Endoscopic

    40. You’ve got it!!!! Hooray!!!