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    1. Page 1

    2. Page 2 ICD-10-Procedure Coding System (ICD-10-PCS) Overview Presented by: Teri L. Jones, RHIT, CCS, CCSP AHIMA Certified ICD-10-CM/PCS Trainer May 7, 2010

    3. Page 3 Table of Contents

    4. Page 4 Section 1

    5. History of ICD-10 ICD-10 Work on ICD-10 began in 1983 and was completed in 1992. The code set allows more than 155,000 different codes and permits tracking of many new diagnoses and procedures, a significant expansion on the 17,000 codes available in ICD-9. ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in World Health Organization Member States beginning in 1994. Adoption was relatively swift in most of the world. The Czech Republic, Denmark, Romania, Slovakia, and Thailand implemented ICD-10 for mortality coding in 1994, and since that time 33 additional countries have joined them. Some countries have created their own extensions. For example, Australia introduced their first edition of "ICD-10-AM" in 1998, and Canada introduced "ICD-10-CA" in 2000. Page 5

    6. Page 6 Section 2

    7. Goals Improve accuracy and efficiency of coding Reduce training effort Improve communication with physicians Page 7

    8. Page 8 Section 3

    9. Attributes Attributes Completeness All substantially different procedures have a unique code Provides detailed information on procedures Expandability Ample space for capturing new technology and devices The structure of the system allows incorporation of new procedures as unique codes Page 9

    10. Attributes Page 10 Standardized Terminology Includes definitions of the terminology used. While the meaning of specific words can vary in common usage, ICD-10-PCS defines a single meaning for each term used in the system. Logical structure with clear, consistent definitions Multi-axial The system has a multi-axial structure. Each character has the same meaning within a section and across sections to the extent possible

    11. Principles Page 11 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 Limited NOS Option A general body part, approach, or root operation can be used when the level of specificity required is not available in the record or cannot otherwise be obtained

    12. Principles Page 12 Principles Diagnostic information is not included in the code description A 'not elsewhere classified' (NEC) option is allowed for new devices and substances All substantially different procedures are defined

    13. Page 13 Section 4

    14. Code Structure Codes are comprised of seven components Each component is called a "character" All codes are seven characters long Individual units for each character are represented by a letter or number Each unit is called a "value“ 34 possible values for each character Digits 0- 9 Letters A-H, J-N, P-Z Page 14

    15. Character Specification Page 15

    16. System Structure – 16 Sections Page 16 Medical and Surgical Obstetrics Placement Administration Measurement and Monitoring Extracorporeal Assistance and Performance Extracorporeal Therapies Osteopathic

    17. Page 17 Section 5

    18. 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 Page 18

    19. ICD-10-PCS Index Provides the first three or four values of the code The tables must always be used to obtain the complete code No eponyms are included Page 19

    20. Index Conventions Main index term is a root operation, root procedure type, or common procedure name Examples: Resection (root operation) Fluoroscopy (root type) Prostatectomy (common procedure name) Secondary entries are specific to the main term Body system Body part Device Page 20

    21. Index Conventions Index Entry by Root Operation Bypass by Body System .... Gastrointestinal System 0D1 .... Heart and Great Vessels 021.... Hepatobiliary and Pancreas 0F1 .... Lower Arteries 041 .... Lower Veins 061 .... Page 21

    22. ICD-10-PCS Tables Bypass by Body Part Artery Aorta, Abdominal 0410... Aorta, Thoracic 021W... Axillary 031... Brachial 031... Common Carotid 031... Page 22

    23. Section (Character 1) Defines the general type of procedure In the Medical and Surgical Section the first character is always the number “0” Page 23

    24. Body System (Character 2) Defines the general physiological system on which the procedure is performed, or anatomical region where the procedure is performed Uses generally accepted anatomical or physiological categories Some traditional categories are subdivided into several body systems Cardiovascular is subdivided into five body systems: Heart and Great Vessels Upper Veins Lower Veins Lower Arteries Page 24

    25. Medical and Surgical Section Body Systems Central Nervous Subcutaneous Tissue and Fascia Peripheral Nervous Muscles Heart and Great Vessels Tendons Upper Arteries Bursae and Ligaments Lower Arteries Head and Facial Bones Upper Veins Upper Bones Lower Veins Lower Bones Lymphatic and Hemic Upper Joints Eye Lower Joints Ear, Nose, Sinus Urinary Respiratory Female Reproductive Mouth and Throat Male Reproductive Gastrointestinal Anatomical Regions, General Hepatobiliary and Pancreas Anatomical Regions , Upper Extremities Endocrine Anatomical Regions, Lower Extremities Skin and Breast Page 25

    26. Root Operation (Character 3) Defines the objective of the procedure 31 different root operation values Each root operation identifies a precise and distinct objective Page 26

    27. Medical and Surgical Section Root Operations Alteration Extirpation Removal Bypass Extraction Repair Change Fragmentation Replacement Control Fusion Reposition Creation Insertion Resection Destruction Inspection Restriction Detachment Map Revision Dilation Occlusion Supplement Division Reattachment Transfer Excision Release Transplantation Page 27

    28. Examples of Definitions RESECTION Definition: Cutting out or off, without replacement, all of a body part Examples: Total nephrectomy Total lobectomy of lung Page 28

    29. Examples of Definitions 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: Dilation and curettage Vein stripping Page 29

    30. Examples of Definitions REMOVAL Definition: Taking out or off a device from a body part Explanation: If the device is taken out and a similar device is put in with out cutting or puncturing the skin or mucous membrane, the procedure is coded to the root operation Change. Other, the procedure for taking out the device is coded to the root operation Removal and the procedure for putting in the new device is coded to the root operation performed Examples: Drainage tube removal Cardiac pacemaker removal Page 30

    31. Body Part/Region (Character 4) Defines the specific anatomical site where the procedure is performed 34 possible body part values in each body system Page 31

    32. Medical and Surgical Section Body Part – Values: Hepatobiliary and Pancreas Liver Cystic Duct Liver, Right Lobe Common Bile Duct Liver, Left Lobe Ampulla of Vater Gallbladder Pancreatic Duct Hepatic Duct, Right Pancreatic Duct, Accessory Hepatic Duct, Left Pancreas Page 32

    33. Approach (Character 5) Defines the technique used to reach the site of the procedure 7 different approach values Approaches through the skin or mucous membrane Open Open with Percutaneous Endoscopic Assistance Percutaneous Percutaneous Endoscopic Assistance Page 33

    34. Medical Surgical Section Approach Approaches through an orifice Via Natural or Artificial Opening Via Natural or Artificial Opening Endoscopic 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 Example: Closed fracture reduction Page 34

    35. Device (Character 6) The term “device” includes only devices that remain after the procedure is completed Instruments that describe how a procedure is performed are not specified in the device character Instruments incidental to a procedures such as clips and sutures are note considered devices Material incidental to a procedure such as a clips and sutures are not considered devices Page 35

    36. Examples of Device Values Drainage Device Radioactive Element Autologous Tissue Substitute Extraluminal Device Intraluminal Device Synthetic Substitute Nonautologous Tissue Substitute Page 36

    37. Qualifier (Character 7) Defines an additional attribute of the procedure performed, if applicable May have a narrow application, to a specific root operation, body system, or body part Examples: Type of transplant Second site for a bypass Diagnostic excision (biopsy) Page 37

    38. Page 38 Section 6

    39. Comparison: ICD-9 Procedure and ICD-10-PCS Page 39

    40. ICD-9-CM / ICD-10-PCS Excision of lesion of tendon sheath hand/wrist ICD-9-CM 82.21 82 = operation on muscle tendon and fascia of hand 2 = excision lesion of muscle, tendon and fascia of hand 1 = excision lesion of tendon sheath of hand ICD-10-PCS OL850ZZ O = section (medical and surgical) L = body system (tendon) 8 = root operation (excision) 5 = body part (forearm and wrist tendon, right) 0 = surgical approach (open) Z = device (N/A) Z = qualifier (N/A) Page 40

    41. Website References http://www.cdc.gov/nchs/about/otheract/icd9/abticd10.htm http://www.cms.hhs.gov/ICD10/02m_2009_ICD_10_CM.asp#TopOfPage http://www.coms.hhs.gov/ICD10/01m_2009_ICD10PCS.asp#TopOfPage Page 41

    42. Website References Page 42

    43. Website Resources Page 43

    44. ??????? Questions Page 44

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