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Introduction to ICD-10 PCS

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  1. Introduction to ICD-10 PCS Presented by: Therese Campbell, CCS Stephanie Carlisto, RHIT, CCS AHIMA-Approved ICD-10-CM/PCS Trainers

  2. ICD-10-PCS History, Structure and OrganizationHistory of ICD-10-PCS and General Structure Introduction Volume 3 of the International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) has been used in the U.S. for the reporting of inpatient procedures since 1979. The structure of Volume 3 of ICD-9-CM is outdated and doesn’t allow for new procedures associated with rapidly changing technology to be effectively intergraded as new codes. As a result, in 1992 the U.S. Centers for Medicare and Medicaid Services (CMS) funded a project to develop a replacement for Volume 3 of ICD-9-CM. After reviewing the preliminary design, CMS in 1995 awarded 3M Health Information Systems a three-year contract to complete development of the replacement system. The new system is the ICD-10 Procedure Coding System (ICD-10-PCS). The new system will be implemented in the U.S. on October 1, 2013. ???????????

  3. History of PCS • 1995 - 1996: First draft of ICD-10-PCS completed • 1996 - 1997: Training program developed Informal testing conducted ICD-10-PCS was revised • 1997 - 1998: Independent formal testing conducted ICD-10-PCS was revised and the Final draft completed • 1998-present ICD-10-PCS updated annually

  4. 2011 ICD-10-PCS available at www.cms.hhs.gov/ICD10 • 2011 Code Tables and Index • ICD-10-PCS 2011 Tables • Definitions • Index • ICD-10-PCS: The Complete Official Draft Code Set 2011 • AHIMA ICD-10-PCS Coder Training Manual

  5. ICD-10-PCS History, Structure and OrganizationHistory of ICD-10-PCS and General Structure There are 4 key attributes that were considered during the development of ICD-10-PCS. This table defines these characteristics. Key Attributes of ICD-10-PCS

  6. ICD-10-PCS History, Structure and OrganizationICD-10-PCS Code Structure

  7. Why is this new system going to make us happy? Expandability: It is flexible, new procedures and new technologies are easily incorporated. Code expansions do not disrupt the structure of the system. Comprehensive: There is limited use of NOS and NEC. Complete detail is provided for all types of procedures. All settings and types of providers are covered except physician offices for E&M coding. Multi-axial: There are specific characters to specify the body system affected. Technology used is specified in the approach character. Devices are easily captured. Best of all, no diagnostic information included in the code

  8. How It’s Organized ICD-10 PCS is composed of 16 sections, and are represented by the numbers 0-9 and the letter B through D and F through H. Procedure characters in these sections range from surgical procedures to substance abuse treatment. The 16 sections are subdivided into 3 main sections: Medical and Surgical 0 Medical and Surgical Related 1-9 Ancillary B-D and F-H

  9. Constructing Codes Medical and Surgical Section 0 Medical and Surgical Medical and Surgical Related Sections 1 Obstetrics 2 Placement 3 Administration 4 Measurement and Monitoring 5 Extracorporeal Assistance and Performance 6 Extracorporeal Therapies 7 Osteopathic 8 Other Procedure 9 Chiropractic

  10. Constructing Codes Ancillary Section B Imaging C Nuclear Medicine D Radiation Oncology F Physical Rehabilitation G Mental Health H Substance Abuse and Treatment

  11. Constructing Codes • Constructing codes in ICD-10-PCS is logical and it’s consistent: Individual numbers and letters referred to as “values”, are selected in sequence to build the seven character code. These seven spaces are referred to as “characters.” • ALSO: • Tables easier to navigate • They provide information quickly about a procedure

  12. ICD-10-PCS Section The first character of a code determines the broad procedure, section or category where the code is located. For example the Medical and Surgical section which contains the majority of procedures coded in the inpatient setting, has a value of “0”

  13. ICD-10-PCS Section

  14. ICD-10-PCS Body System The second character is body system which is the anatomical region or physiological system involved in a procedure. It is the general region of the body where the procedure is being performed.

  15. Body System Values

  16. Body System Values

  17. Body System Values

  18. Body System Values

  19. ICD-10-PCS Root Operation The third character is the root operation, or the objective of the procedure being performed. Some examples of root operations are Excision, Resection, Drainage and Extraction.

  20. Root Operations

  21. ICD-10-PCS Body Part The fourth character is body part or the specific anatomical site where the procedure was performed. It is the defined body part, where the second character “body system” only indicates the general region of the procedure being performed. An example of body part is Liver.

  22. ICD-10-PCS Approach The fifth character defines the approach, or technique employed to reach the operative site. There are seven different approach values used in the Medical Surgical section.

  23. ICD-10-PCS Approach

  24. ICD-10-PCS Device The sixth character is the device used depending on the procedure being performed. There may or may not be a device left in place at the end of a procedure. If there is no device left in place after the procedure, the value is “Z” to represent NO DEVICE.

  25. ICD-10-PCS Device

  26. ICD-10-PCS Qualifier The seventh character is the qualifier for a particular code. A qualifier specifies an attribute of the procedure for additional information regarding the procedure, if it applies.

  27. ICD-10-PCS Qualifier Type of Transplant: Heart Liver Second Site for Bypass: Aorta Ascending colon Cystic Duct Diagnostic excision (biopsy) acts as a qualifier(X) Most procedures don’t have applicable qualifiers therefore the default value to indicate no qualifier is “Z”

  28. Constructing Codes

  29. Organization Medical Surgical Related Sections Sections 1 and 2 the definitions are the same for all seven characters or the same meaning as procedures in the Medical Surgical section 0. In sections 3 through 9, it is basically the same, but there are some exceptions. In section 5 and 6 the 5th character is defined as duration, not approach. • Section 3 the 6th character is substance • Sections 4 and 5, 6th character is function • Sections 7 through 9, 6th character is method

  30. Organization Medical Surgical

  31. Organization Medical Surgical

  32. Organization Ancillary Section The ancillary section of ICD-10-PCS include sections B through D and F through H.

  33. Organization Ancillary Section The ancillary section differs from previous sections. In the imaging section, the 3rd character is defined as root type, and the 5th and 6th characters define contrast and contrast/qualifier. Other differences include: • Section C nuclear medicine 5th character is radionuclide • Section D radiation oncology 5th character is a modality qualifier and the 6th character is an isotope • Section F Physical Rehab and Diagnostic Audiology the 5th character is a type qualifier and the 6th character is equipment used • Section G and H Mental Health and Substance abuse the 4th character is a type qualifier

  34. Organization Ancillary Section

  35. Organization Ancillary Section

  36. ICD-10-PCS Approaches • Fifth character – approach or technique used to reach procedure • Seven different approach values

  37. Approaches Skin or mucous membranes Through an orifice • Open • Percutaneous • Percutaneous Endoscopic • Via Natural or Artificial Opening • Via Natural or Artificial Opening Endoscopic • Via Natural or Artificial Opening With Percutaneous Endoscopic Assistance

  38. Approaches

  39. OPEN APPROACH VALUE 0 EXAMPLES • Cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure. • Open CABG • Open endarterectomy • Open resection cecum • Abdominal hysterectomy Abdominal hysterectomy

  40. PERCUTANEOUS NEEDLE LIVER BIOPSY • EXAMPLE OF PERCUTANEOUS APPROACH • VALUE 3

  41. PERCUTANEOUSAPPROACH Value 3 Example • 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. • Percutaneous needle core biopsy of kidney • Liposuction • Percutaneous drainage of ascites • Needle biopsy of liver

  42. LAPAROSCOPIC CHOLECYSTECTOMY VS OPEN CHOLECYSTECTOMY EXAMPLE OF PERCUTANEOUS ENDOSCOPIC APPROACH VALUE 4

  43. PERCUTANEOUSENDOSCOPIC Value 4 Example • 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. • Laparoscopic cholecystectomy • Laparoscopy with destruction of endometrium • Endoscopic drainage of sinus • Arthroscopy

  44. APPROACH: VIA NATURAL OR ARTIFICIAL OPENING VALUE: 7 ENDOTRACHEAL INTUBATION

  45. VIA NATURAL OR ARTIFICIAL OPENING VALUE 7 EXAMPLES • Entry of instrumentation through a natural or artificial external opening to reach the site of the procedure. • Foley catheter placement • Transvaginal intraluminal cervical cerclage • Digital rectal exam • Endotracheal intubation

  46. ESOPHAGOGASTRODUODENOSCOPY • APPROACH: VIA NATURAL OR ARTIFICIAL OPENING ENDOSOCPIC • VALUE: 8

  47. VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC VALUE 8 EXAMPLES • Entry of instrumentation through a natural or artificial external opening to reach and visualize the site of the procedure • Transurethral cystoscopy with removal of bladder stone • ERCP • Hysteroscopy • Colonoscopy

  48. VIA NATURAL OR ARTIFICIAL OPENING WITH PERCUTANEOUS ENDOSCOPIC ASSISTANCEValue F

  49. VIA NATURAL OR ARTIFICIAL OPENING WITH PERCUTANEOUS ENDOSCOPIC ASSISTANCE VALUE F EXAMPLES • 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. • Laparoscopic-assisted vaginal hysterectomy (LAVH)

  50. INTERDENTAL WIRING FOR TREATMENT OF MANDIBULAR FRACTURE EXTERNAL APPROACH VALUE X