crossing the bridge preparing for icd-10-pcs crystal clack, ms, rhia, ccs ahima approved...

Crossing the Bridge

Preparing for ICD-10-PCS

Crystal Clack, MS, RHIA, CCSAHIMA Approved ICD-10-CM/PCS Trainer

OrHIMA Fall Conference 2013

Objectives A Brief History ICD-9-CM, Vol. 3 to ICD-10-PCS Format and Structure of ICD-10-PCS Spotlight: Root Operations Practice Preparing for the Great Transition Conclusion Resources

A Brief History

Why Now?

ICD-10-PCS is completely different from ICD-9-CM, Vol. 3

•Multi-axial structure

•Completeness

•Expandability

•Standardized terminology

•Standardized level of specificity

•No explicit options of “NOS” and limited use of “NEC”

code

ICD-9-CM Vol. 3 vs ICD-10-PCS

ICD-9-CM Volume 3 ICD-10-PCS

Follows ICD structure (designed for DX coding)

Designed and developed to meet healthcare needs for a procedure coding system

Codes available as fixed and finite set in list form

Codes constructed from flexible code components using Table

Codes are 3 to 4 digits long with a decimal point places after the second digit

Codes are 7 characters long

Codes are numeric Codes are alphanumeric

Number of Codes in ICD-10-PCS at the time of printing the 2014 Official Draft Code Set manual:

71,924

For 2014, seven new technology codes were added to the system, and three were deleted.

Format & Structure

Manual contains an Index and Table section

Codes may be found in the index based on the general type

of procedure. Based on the first three values of the code

provided in the Index, the table that corresponds to the

procedure can be referenced to complete the entire code.

Tables and characters are arranged as follows:

•Number

•Letter for each character, with a total of 7 characters

IMPORTANT: The Tables must be used to paint a complete and accurate

picture!

ICD-10-PCS Format & Structure

• Each code is seven characters and can be alphabetical

or numeric

• Ten digits 0-9 and 24 letters A-H, J-N, and P-Z are used

• Each of the characters has a well-defined meaning

Section ~ Character 1

• All Codes in PCS are seven characters

• Letters O and I are not used – 0 and 1 are used

• Each number has a meaning

• Meanings change depending on sections

• Section provides first character value

Section

Medical procedures are divided into sections that identify

the general type of procedure. The first character of the

procedure code always specifies the section – or where

you can locate the code in the book.

Sections of ICD-10-PCS as follows:

Value Section Value Section0 Medical & Surgical 9 Chiropractic

1 Obstetrics B Imaging

2 Placement C Nuclear Med

3 Administration D Radiation Tx

4 Measuring & Monitoring FPhysical Rehab &

Diagnostic Audiology

5Extracorporeal Assistance & Performance

G Mental Health

6Extracorporeal

TherapiesH

Substance Abuse Treatment

7 OsteopathicBOLD italics =

Ancillary

8 Other Procedures

Body System~ Character 2

• Second character

• Body System, general physiological system or anatomical

region involved

• Review Body Systems in training manual

• Appendix G

Body System0 - Central Nervous Sys.

C – Mouth & Throat Q – Lower Bones

1 – Peripheral Nervous Sys

D – Gastro System R – Upper Joints

2 – Heart & Great Vessels

F – Hepatobiliary System & Pancreas

S – Lower Joints

3 – Upper Arteries G – Endocrine System T – Urinary System

4 – Lower Arteries H – Skin & BreastU – Female Reproductive System

5 – Upper Veins J – SQ Tissue & FasciaV – Male Reproductive System

6 – Lower Veins K – MusclesW – Anatomical Regions, General

7 – Lymphatic & Hemic L - TendonsX – Anatomical Regions, Upper Extremities

8 – Eye M – Bursae & LigamentsY – Anatomical Regions, Lower Extremities

9 – Ear Nose & Sinus N – Head & Facial Bones

B – Respiratory System P – Upper Bones

Root Operations ~ Character 3

• Objective of Procedure

• 31 root operations

• Arranged by similar attributes

• Multiple codes

Examples of Root Operations

Bypass

Drainage

Reattachment

Resection

Inspection

Root Operations

Alteration Division Inspection Reposition

Bypass Drainage Map Resection

Change Excision Occlusion Restriction

Control Extirpation Reattachment Revision

Creation Extraction Release Supplement

Destruction Fragmentation Removal Transfer

Detachment Fusion Repair Transplantation

Dilation Insertion Replacement

There are 31 different root operations! The root is the reason, or objective, for the procedure

Body Part ~ Character 4

• Fourth character

• Anatomical site for procedure

• 34 possible values per body system

Examples of Body Parts

Liver

Kidney

Thalamus

Ascending Colon

Optic Nerve

Tonsil

Axillary vein, left

Radial nerve

Cerebellum

Upper lung lobe

(R)

Approach ~ Character 5

• Fifth character – approach or technique used to reach

procedure

• Seven different approach values

• May be through: skin, mucous membrane, orifice or

external

Examples of Approaches Skin or Mucous Membranes

~ Open, percutaneous or percutaneous endoscopic

Through an Orifice~ Via Natural or Artificial Opening~ Via Natural or Artificial Opening

Endoscopically~ Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance

External

Root Operations~ Character 5

Approach contains three components:

•Access location

•Method

•Type of instrumentation

Types of approaches:

•Open

•Percutaneous & percutaneous endoscopic

•Via natural/artificial Opening

•Natural/Artificial Opening Endoscopic

•Natural/Artificial Opening with Percutaneous Endoscopic Assistance

•External

Device ~ Character 6

Only procedures with a remaining device after the procedure will have a

specific device value. All codes require seven characters. The default

value to indicate that NO device was involved is Z.

Materials incidental to the procedure (clips and sutures)

are not considered devices.

Four Groups of Devices

Grafts

Prostheses

Implants

Simple or Mechanical Appliances

Electronic Appliances

Qualifier ~ Character 7

• Provides additional information

• May have narrow application

• There are NO specific guidelines for qualifiers

Most procedures will not have an

applicable qualifier…the default value to

indicate that NO qualifier

is necessary is…… Z

TIP!

Simple Way to Remember the Seven Character

Meanings!Sally = Selection

Bought = Body System

Root = Root Operation

Beer = Body Part

At = Approach

Dairy = Device

Queen = Qualifier

True or False?

A biological or synthetic material that takes the place of all or a portion of a body part such as a joint prosthesis would qualify as a device in ICD-10-PCS.

A: True

Rationale: A device is specified in the sixth character and is used to identify devices that remain after the procedure is complete

Test Your Knowledge

1. All ICD-10-PCS codes have _____________ characters.a. 3 to 5b. 3 to 7c. 5 to 7d. 7

2. Materials such as sutures, ligatures, radiological markers, and temporary postop wound drains should be coded separately using ICD-10-PCS device codes

a. Trueb. False

3. When coding in ICD-10-PCS, it is necessary to consult the Alphabetic Index and then proceed to the Tables.

a. Trueb. False

Medical and Surgical Section (0):

Root Operations

ROOT OPERATIONS

There are 31 root operations in ICD-10-PCS; each

identifies the objective of a procedure and holds the key

to the highly specific details and precision of the code

values.

Root Operation GuidelinesB3. Root Operation - General guidelines

B3.1a. In order to determine the appropriate root operation, the full definition of the root operation as contained in the PCS Tables must be applied

B3.1b Components of a procedure specified in the root operation definition are not coded separately. Procedural steps necessary to reach the operative site and close the operative site are also not coded separately.

EXAMPLES:

Resection of a joint as part of a joint replacement procedure is included in the root operation definition of Replacement and is not coded separately. Laparotomy performed to reach the site of an open liver biopsy is not coded separately. In a resection of sigmoid colon with anastomosis of descending colon to rectum, the anastomosis is not coded separately.

B3. Root Operation - General guidelines continued:

B3.2. Multiple Procedures:During the same operative episode, multiple procedures are coded if:

a. The same root operation is performed on different body parts as defined by distinct values of the body part character.

b. The same root operation is repeated at different body sites that are included in the same body part value.

c. Multiple root operations with distinct objectives are performed on the same

body partd. The intended root operation is attempted using

one approach, but it converted to a different approach

B3. Root Operation - General guidelines continued:

B3.3. Discontinued Procedures:If the intended procedure is discontinued, code the procedure to the root operation performed. If a procedure is discontinued before any other root operation is performed, code the root operation inspection of the body part or anatomical region inspected

B3.4a. Biopsy Procedures:Are coded using the root operations, Extraction, or Drainage and the qualifier Diagnostic. The qualifier Diagnostic is ONLY used for biopsies

B3.4b. Biopsy followed by a more definitive treatment:If a diagnostic Excision, Extraction, or Drainage procedure is followed by a more definitive procedure, such as Destruction, Excision or Resection at the same procedure site, both the biopsy and more definitive treatment are coded

Medical & Surgical Section:Root Operations That Take Out

Some/All of a Body Part

Excision B:

Definition: Cutting out or off, without replacement, a portion of a body part

Explanation: The qualifier DIAGNOSTIC is used to identify excision procedures that are biopsies

Examples: Partial Nephrectomy, Liver biopsy

Example Case One

A 32-year-old female patient experienced melena gradually worsening over the last five days. Patient complains of weakness and dizziness to the point of passing out at work. She was admitted to the hospital for observation and an EGD. An EGD of the duodenum was performed the following morning.

What is the ICD-10-PCS code for this procedure?

Root operation: _________________________________Specific Body Part: _________________________________Seventh Character: _________________________________

ICD-10-PCS Code: _________________________________

Example Case One Snapshot of PCS Coding Book

Answer Case One

What is the ICD-10-PCS code for this procedure?

Root operation: Excision

Specific Body Part: Duodenum identified with 4th character

Seventh Character: “X” for diagnostic

ICD-10-PCS Code: 0DB98ZX

Medical & Surgical Section:Root Operation - Resection

Resection - T:

Definition: Cutting out, or off, without replacement, all of a body part

Explanation: N/A

Examples: Total Nephrectomy, total lobectomy of lung

Example Case TwoA 45-year-old male patient was diagnoses with acquired hemolytic anemia, autoimmune type with warm-reactive antibodies, and has been treated with glucocoricoids. Given the aggressive nature of his anemia, he was advised to have a total splenectomy to eliminate the body’s further destruction of red blood cells. Open splenectomy was performed without complications.

What is the ICD-10-PCS code for this procedure?

Root operation: _________________________________Specific Body Part: _________________________________Seventh Character: _________________________________

ICD-10-PCS Code: _________________________________

Example Case Two Snapshot of PCS Coding Book

Answer Case Two

What is the ICD-10-PCS code for this procedure?

Root operation: Resection

Specific Body Part: No device

Seventh Character: No qualifier

ICD-10-PCS Code: 07TP0ZZ

Medical & Surgical Section:Root Operations That Always Involve a

DeviceB6. Device

B6.1a. A device is coded only if a device remains after the procedure is completed, if no device remains, the device value No Device is coded.

B6.1b. Materials such a sutures, ligatures, radiological markers and temporary post-operative wound drains are considered integral to the performance of a procedure and not coded as devices.

B6.1.c.Procedures performed on a device only and not on a body part are specified in the root operations

Change, Irrigation, Removal and Revision and are coded to the procedure performed.

Medical & Surgical Section:Root Operation - Replacement

Replacement - R:

Definition: Putting in or on a biological or synthetic material that physically takes the place and/or

function of all or a portion of the body part.

Explanation: The body part may have been taken out or replaced, or may be taken out, physically eradicated or rendered nonfunctional. A Removal procedure is coded for taking out the device used in previous replacement procedure.

Example Case Three

The patient had a total right knee replacement 9 years ago. The patient was found to have an aseptic loosening and it was recommended to have total knee revision arthroplasty. The patient was taken to the OR where a ® TKR revision was carried out. During the procedure the previous prosthetic device was removed and a new cemented prosthetic device was inserted.

What is the ICD-10-PCS code for this procedure?

Root operation: _________________________________Specific Body Part: _________________________________Seventh Character: _________________________________

ICD-10-PCS Code: _________________________________

Example Case Three Snapshot of PCS Coding Book

What is the ICD-10-PCS code for this procedure?

Root operation: Replacement

Specific Body Part: Knee component and laterality

Seventh Character: cemented

ICD-10-PCS Code: 0SRC0J9

Answer Case Three

DO WE HAVE TO CLIMB THAT?!

Preparing for the

Inevitable:

10/01/2014

Don’t be a Fish out of Water!

Brush up on your anatomy

Review your pathophysiology

Don’t procrastinate!

START NOW

Many, Many Web Resources!

1. http://www.ahima.org/icd10/

2. http://www.aapc.com/icd-10/

3. http://www.cms.gov/Medicare/Coding/ICD10/

index.html?redirect=/icd10

4. http://www.himss.org/library/icd-10/playbook?

navItemNumber=13480

5. http://health-information.advanceweb.com/ICD-10-Resource-

Center/default.aspx

6. www.fortherecordmag.com

Application of ICD-10-PCS Root Operations, Audio Seminar, October 23, 2012

AHIMA

ICD-10-CM Official Guidelines for Coding and Reporting 2014:

http://www.cdc.gov/nchs/data/icd9/icd10cm_guidelines_2014.pdf

ICD-10-PCS Code Set: http://www.cdc.gov/nchs/icd/icd10cm.htm/

ICD-10-PCS, The Complete Official Draft Code Set 2014, Optum

Root Operations: Key to Procedure Coding in ICD-10-PCS, Ann Barta & Ann

Zeisset, AHIMA, 2011

Resources Used

Summer, 2015…..Life is Good!