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What is ICD-10-PCS?
 
 

What is ICD-10-PCS?

 

The International Classification of Disease, Tenth Revision, Procedure Coding System (ICD-10-PCS) was developed to accompany the WHO's ICD-10-CM diagnosis classification system. The ICD-10-PCS enables each code to have a standard structure, be descriptive, and expand to accommodate future needs. This procedure coding system is used to gather data, collect information, determine payment, and support the electronic health record for all inpatient services and procedures performed in the U.S. Codes can be built from the index, tables, and appendices provided in the ICD-10-PCS manual. With this coding system, each character of the seven-digit code has a characteristic attribute that is used to provide a detailed explanation of the medical procedure provided (Davis, 2011).

History of ICD-10-PCS

The reporting of hospital procedures has been done using Volume 3 of the ICD-9-CM since 1970. This system became outdated and incapable of expansion. In 1992, CMS developed the ICD-10-PCS with 3M Health Information Systems. This system has a multiaxial seven-character alphanumeric code structure. During the ICD-10-PCS development, CMS followed several general principles. When procedures are performed for certain disorders, the disorder is not listed in the procedure code. Also, there is restriction of use of NOS options, with a minimal level of specificity required for each procedural component. Also, there is limited use of the NEC option, but some availability does exist. Finally, all procedures performed now can be specified with ICD-10-PCS (Barta, DeVault, & Zeisset, 2011).

ICD-10-PCS Code Structure

Because of many structural issues with ICD-9-CM, codes in ICD-10-PCS meet specific objectives, essential characteristics, and follow general guidelines. This allows for the coder to meet today's data requirements. This is a major step toward building a health information infrastructure that is suited for the current electronic era. All codes in ICD-10-PCS are seven characters in length, and each of these characters represents a particular aspect of the procedure (Barta, DeVault, & Zeisset, 2011).

Medical and Surgical Section Code Structure

Character

Character

Character

Character

Character

Character

Character

1

2

3

4

5

6

7

Section

Body System

Root Operation

Body Part

Approach

Device

Qualifier

Comparison between Code Structure ICD-9-CM vs. ICD-10-PCS

ICD-9-CM

ICD-10-PCS

Designed for diagnostic coding (follows ICD structure)

Designed to meet healthcare needs for procedure coding

Codes are fixed in list form.

Codes are constructed from flexible code components using tables.

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Codes are 3 to 4 digits in length with a decimal point after the 2nd digit.

Codes are seven characters long.

Codes are numeric.

Codes are alphanumeric.

(Barta, DeVault, & Zeisset, 2011)

ICD-10-PCS System Organization

ICD-10-PCS has 16 sections, which are represented by numbers 0 through 9 and letters B through D and F through H. The procedure categories of these sections are broad, ranging from surgical procedures to substance abuse treatment. The 16 sections are divided into three main subsections: Medical and Surgical, Medical and Surgical-Related, and Ancillary (Barta, DeVault, & Zeisset, 2011).

Medical and Surgical

The first subsection is the Medical and Surgical, which contains the majority of procedures usually reported in the inpatient environment. The code structure involves character 1: section, character 2: body system, character 3: root operation, character 4: body part, character 5: approach, character 6: device, and character 7: qualifier (Barta, DeVault, & Zeisset, 2011).

Medical and Surgical-Related

The Medical and Surgical-Related subsection has 9 components, which are referred to as "section value." These include:

Section Value

Description

1

Obstetrics

2

Placement

3

Administration

4

Measurement and Monitoring

5

Extracorporeal Assistance and Performance

6

Extracorporeal Therapies

7

Osteopathic

8

Other Procedures

9

Chiropractic (Barta, DeVault, & Zeisset, 2011)

For section values 1 and 2, obstetrics and placement respectively, all seven characters have the same meaning as the procedures in the first subsection (Medical and Surgical). For codes in section values 3 through 9, however, the structure is slightly different. Section 3 defines the sixth character as substance, sections 4 and 5 define the sixth character as function, sections 5 and 6 define the fifth character as duration, and sections 7 through 9 define the sixth character as method (Barta, DeVault, & Zeisset, 2011).

Ancillary

Section values B through D and F through H are in the Ancillary subsection. These include:

Section Value

Description

B

Imaging

C

Nuclear Medicine

D

Radiation Oncology

F

Physical Rehabilitation and Diagnostic Audiology

G

Mental Health

H

Substance Abuse Treatment (Barta, DeVault, & Zeisset, 2011)

The definitions of several characters in the Ancillary subsection are different from those in the previous subsections. In section value B, Imaging, the third character is defined as the root type and the fifth and sixth characters are defined as contrast and contrast qualifier respectively. Also, section value C defines the fifth character as radionuclide, section value D defines it as modality qualifier, and section value F defines it as type qualifier (Barta, DeVault, & Zeisset, 2011).

Basic ICD-10-PCS Coding Steps 

Step 1: Locate the Main Term in the Alphabetic Index

The first step to coding with ICD-10-PCS is to locate the main term in the Alphabetic Index. The main terms are often common procedures, such as Appendectomy and Cholecystectomy. They could also be a root operation value, such as Excision or Resection, or they may be body parts, such as Arm or Leg. Examples: 

Claviculectomy

--see Excision, Upper Bones [0PB]

--see Resection, Upper Bones [0PT] 

Excision

-Acetabulum

--Left [0QB5]

--Right [0QB4]

-Adenoids [0CBQ] 

Adductor hallucis muscle

--use Muscle, Foot, Left

--use Muscle, Foot, Right 

(Leon-Chisen, 2011)

Step 2: Find the Applicable Table

Once the coder finds the first three or more code characters in the Alphabetic Index, the next step is to refer to the appropriate Table. To do this, the coder can use the PDF version on the CMS website, where the Tables can be accessed by clicking on the link that is provided in the Index. When using the ICD-10-PCS book, the coder must locate the Tables, which are arranged in a series. The coder has to review the section, body system, and root operation definition and then check to see if the first three characters referenced by the Index match (Leon-Chisen, 2011).

Step 3: Continue Code Building

The coder can continue building the ICD-10-PCS code by selecting a value from each column for the remaining four characters. To do this, the coder selects the fourth character from the body part column, selects the fifth character from the approach column, selects the sixth character from the device column, and selects the seventh character from the qualifier column (Leon-Chisen, 2011).

 
 
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