ICD-10-PCS, Root Operations – Part 30, Procedures: Question & Answer

ICD-10-PCS, Root Operations – Part 30, Procedures: Question & Answer

This week we will continue to focus on procedures in the Administration section. If you need to review anything from last week’s discussion, please refer to the 1/20/15 tidbit.

 

Coding Problems for this week:

  1. Chemical pleurodesis through chest tube with injection of tetracycline.
  2. Open implantation of antimicrobial envelope with cardiac pacemaker placement (do not code pacemaker.

 

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

Answer Key:

  1. 3E0L3TZ
  2. 3E0102A

 

Problem #1, Chemical pleurodesis through chest tube with injection of tetracycline.

To Locate:  PCS Index > Introduction of Substance In or on > Pleural Cavity > Destructive Agent > 3E0L3TZ > Locate table 3E0 and after locating the appropriate row, go across the row to confirm that the code listed in the Index is correct:

Introduction of Destructive Agent into Pleural Cavity, Percutaneous Approach

PCS Root Ops 30A

Comments:

  • Always start your Index search by first referring to the Root Operation. In our scenario, it is Introduction. Introduction is defined as “Putting in or on a therapeutic, diagnostic, nutritional, physiological or prophylactic substance except blood or blood products.” Think of injections when you come across the term Introduction. Introduction, in fact, is part of the new terminology found in ICD-10-PCS with Introduction replacing Injection.
  • Pleurodesis is a medical procedure in which the pleural space is artificially obliterated. It involves the adhesion of the two pleurae. Chemicals such as bleomycin, tetracycline, et al, or iodine, or a slurry of talc can be introduced into the pleural space through a chest drain. The instilled chemicals cause irritation between the parietal and the visceral layers of the pleura which closes off the space between them and prevents further fluid from accumulating. Well, what do you know – I had no idea tetracycline was anything other than an anti-infective.
  • Once you are in table 3E0, search very carefully for the 4th character Body Part. There are multiple rows in table 3E0, so don’t stop when you come to the first ‘L.” Keep going.

 

Problem #2, Open implantation of antimicrobial envelope with cardiac pacemaker placement (do not code pacemaker.)

To Locate:  PCS Index > Introduction of substance in or on > Subcutaneous Tissue > Anti-infective > 3E01 > Locate table 3E0 and then 1) locate the appropriate row and 2) go across the row to finish building the code:

Introduction of Anti-infective Envelope into Subcutaneous Tissue, Open Approach

PCS Root Ops 30B

Comments:

  • This was harder to code, at least for me.  The first place I went to in the Index was Implantation where there are instruction to see either Insertion or Replacement. Insertion made sense, but it didn’t take me to the correct table. You don’t have to rely on the Index. Many coders find it easier to go directly to the tables. However, you need to develop a strong comfort zone before working directly with the tables.
  • How do you know the Body Part is subcutaneous tissue? You will know this based on your experience. It is standard procedure to place an envelope or battery just under the skin in the chest area.
  • The Qualifier let us know more about the procedure. In this instance it tells us that the device inserted is an anti-infective envelope.

This week we’re going to focus on the Administration section. This section involves procedures such as transfusions, infusions, injections, and irrigations. With the exception of the 6th character Substance, the characters are the same as those in the Med/Surg section.

 

Coding problems for this week:

  1. Autologous bone marrow transplant via CVC (central venous catheter.)
  2. Epidural injection of mixed steroid and local anesthetic for pain control.

 

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

 

Answer Key:

  1. 30243G0
  2. 3E0S33Z

 

Characters in the Administrative Section:

  • Character 1, Section:  Always 3, Administration
  • Character 2, Body System:  There are only 3 valid character values:  Circulatory (0), Indwelling Device (C), Physiological Systems and Anatomical Regions (E)
  • Character 3, Root Operation:  There are only 3 valid character values:  Introduction, Irrigation, Transfusion.
  • Character 4, Body Region:  The values in this section relate to the substance being administered. For transfusion procedures, the values include only valid routes of administration as through a vein or artery whereas the root operation Introduction contains 33 routes of administration.
  • Character 5, Approach:  The approach is almost always going to be Percutaneous with one exception:  Irrigations of indwelling devices are always coded to External approach.
  • Character 6, Substance:  This character provides broad categories of substances such as anesthetics, anti-inflammatories, antineoplastics and destructive agents, etc.
  • Character , Qualifier:  This character designates more specific information about the substance administered, such as whether a transfusion blood product was Autologous (0), or it provides further specificity about the substance. For example, the 6th character in a code may be 0, Antineoplastic, and the 7th character Qualifier value may be M for Monoclonal Antibody, which further describes the specific type of chemotherapy.

 

Problem #1, Autologous bone marrow transplant via CVC (central venous catheter.)

To Locate:  PCS Index > Transfusion >Vein > Central > Bone Marrow > 3024 > Locate table 302 and go across the row to finish building the code:

Transfusion of Autologous Bone Marrow into Central Vein, Percutaneous Approach

PCS Root Ops 29A

Comments:

  • Root Operation:  Always being your search in the Index by referring to the Root Operation.
  • There are only 3 valid character values in the Administration section of which Transfusion is one of the 3 characters.
  • As previously stated, the approach is almost always Percutaneous. Subcutaneous, intradermal, and intramuscular injections are other examples of the Percutaneous approach.
  • Substance:  If the substance administered is blood or blood products, the Root Operation Transfusion is assigned.
  • The 7th character designates more specific information about the substance administered, such as whether a transfusion was Autologous.

 

Problem #2, Epidural injection of mixed steroid and local anesthetic for pain control.

Introduction of Anti-Inflammatory into Epidural Space, Percutaneous Approach.

PCS Root Ops 29B

Comments:

  • Body System:  ICD-10-PCS does not classify regions of the body by the traditional abdominopelvic quadrant divisions. The anatomical regions are defined as the general regions, the upper extremity regions, and the lower extremity regions. The epidural space is considered a general region.
  • Root Operation:  Introduction is defined as “Putting in or on a therapeutic, diagnostic, nutritional, physiological or prophylactic substance except blood or blood products.” Think of injections when you come across the root operation Introduction.
  • Substance:  Steroids are considered to be anti-inflammatories. There are multiple rows for the tables in 3E0. Don’t give up if you can’t locate the substance because it is listed. Quickly go through the 3E0 tables; first locate the Body Part, 4th character value of S. Once you have 3E0S, you can scan the rows looking for the Substance, anti-inflammatory.
  • The 6th character Substance is coded to 3 Anti-inflammatory because the steroid was the main substance introduced. The local anesthetic was mixed in to lessen the pain of the injection itself.

Today will be our final discussion on procedures in the Obstetrics section.

 

Coding problems for this week:

  1. Abortion by dilation and evacuation following laminaria insertion.
  2. Laparoscopy with total excision of tubal pregnancy.
  3. Open in utero repair of congenital diaphragmatic hernia.

 

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

Answer Key:

  1. 10A07ZW
  2. 10T24ZZ
  3. 10Q00ZK

 

Problem #1, Abortion by dilation and evacuation following laminaria insertion.

To Locate:  PCS Index >Abortion > Laminaria > 10A07ZW > Locate table 10A and validate that the code listed in the Index is correct.

Abortion of Products of Conception, Laminaria Via Natural or Artificial Opening

PCS Root Ops 28A

  • Start with the root operation in the Index.
  • Laminaria is a seaweed product inserted into the cervix for 3-4 hors, which is usually enough time for the cervix to soften and dilate, after which the products of conception are evacuated.

 

Problem #2, Laparoscopy with total excision of tubal pregnancy.

To Locate:  PCS Index > Resection > Products of Conception, Ectopic >10T2 > locate table 10T and go across the row to finish building the code.

Resection of Products of Conception, Ectopic, Percutaneous Approach

PCS Root Ops 28B

  • Resection, the root operation, is defined as “Cutting out or off, without replacement all of a  body part.” How would you know to go to resection? Well, you won’t find anything under excision or dilation that works. In ectopic pregnancies, the entire fetus must be removed. Therefore, resection rather than excision applies.
  • Approach:  Any time a laparoscope is used it is considered percutaneous endoscopic. A puncture is made, after which the scope is inserted.

 

Problem #3, Open in utero repair of congenital diaphragmatic hernia.

To Locate:  PCS Index > Repair > Products of Conception > 10Q0 > Locate table 10Q and go across the row to finish building the code:

Repair Respiratory System in Products of Conception, Open Approach

PCS Root Ops 28C

  • I thought these in utero repairs would be difficult to code, but they’re not. As usual, go to the root operation when using the Index rather than the tables.
  • The diaphragm is classified to the Respiratory body system in the Med/Surg section although we are staying in the OB section, not the Med/Surg section.
  • No guesswork for the approach, as the first word in the first sentence is Open.

For the past several weeks we have focused on Obstetric procedures. We will continue to give you more obstetric coding problems so you can test your skill set based on what you have learned to date.

 

Coding problems for this week:

  1. Intrauterine pregnancy term, delivered full term infant. Episiotomy extended to 2nd-degree lacerations, perineum. A low-forceps delivery with episiotomy and repair of perineal laceration.
  2. Induction of labor by cervical dilation.
  3. Termination of pregnancy as 12 weeks after studies showed the fetus to be anencephalic. A laminaria stick produced an incomplete abortion. This was followed by a D&C.

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key:

  1. 10D07Z3, 0W8NXZZ, 0WQNXZZ
  2. 0U7C7ZZ
  3. 10A07ZW, 10D17ZZ

 

Problem #1, Intrauterine pregnancy, delivered full term infant. Episiotomy extended to 2nd-degree lacerations, perineum. A low-forceps delivery followed by episiotomy and repair of perineal laceration transpired.

To Locate Delivery:  PCS Index > Delivery > Forceps > see Extraction, Products of Conception > 10D0 > Extraction > Products of Conception > Low Forceps > 10D07Z3 > Locate table 103D and validate that the code listed in the Index is correct:

Extraction of Products of Conception, Low Forceps, Via Natural or Artificial Opening

PCS Root Ops 27A 

Comments:

  • If you refer to the root operation, Delivery, Forceps it gives you two instructions: either go to table 10D (listed as 10D0 in the Index) or refer to the root operation Extraction, which gives you the entire code. Regardless of which root operation you referred to, you should still locate the table to verify that the code given in the Index is correct.
  • It is always faster to refer to the root operation in the Index.
  • The Qualifier, which gives us more information about the code, indicates that this was a low forceps delivery.

 

Problem #1 cont’d, to locate Episiotomy:  PCS Index > Episiotomy > see Division, Perineum, Female > 0W8N > locate table 0W8 and go across the row to finish building the code:

Division of Female Perineum, External Approach

PCS Root Ops 27B

Comments:

  • Definition of Division:  Cutting into a body part without draining fluids and/or gases from the body part in order to separate or transect a body part.
  • The External approach is assigned for procedures performed directly on the skin.
  • Note that we have gone from the Obstetrics section to the Med/Surg section. Procedures performed on the pregnant female other than the products of conception are coded to the appropriate root operation in the Med/Surg section.
  • Review:  Products of conception refer to all components of pregnancy including fetus, embryo, amnion, umbilical cord, and placenta.

 

Problem #1 cont’d, to locate repair of perineal laceration:

To Locate:  PCS Index > Perineum > Female > 0WQN > locate table 0WQ and go across the row to finish building the code:

Repair Female Perineum, External Approach

PCS Root Ops 27C

 

Problem #2, Induction of labor by cervical dilation.

To Locate:  PCS Index > Induction > Cervix > 0U7C > Locate table 0U7 and go across the row to finish building the code:

Dilation of Cervix, Via Natural or Artificial Opening

PCS Root Ops 27D 

Comments:

  • We have once again gone from the Obstetrics section to the Med/Surg section. Refer to problem #1 for explanation.
  • Note that the Body Part character value (character 4) is dependent upon the assignment of the Body System character value (character 2). The cervix is considered part of the female reproductive system.

 

Problem #3, Termination of pregnancy as 12 weeks after studies showed the fetus to be anencephalic. A laminaria stick produced an incomplete abortion. This was followed by a D&C.

To Locate abortion:  PCS Index > Abortion > Laminaria >10A07ZW > locate table 10A and go across the row to finish building the code: 

PCS Root Ops 27E

Comments:

  •  A laminaria stick is a thin rod of dried kelp used in Obstetrics for surgical procedures such as abortions. The rods are inserted into the cervix, and over the course of several hours, they slowly absorb water and expand, dilating the cervix and prompting labor.
  • Since the rods are injected into the cervix, it is logical to assign the approach as percutaneous. However, the ICD-10-PCS coding book does not give you a choice. The only approach listed is Via Natural or Artificial Opening.

 

Problem #3 cont’d, to locate D&C:

PCS Index > Extraction > Products of Conception > Retained > 10D1 > locate table 10D and go across the row to finish building the code:

Extraction of Products of Conception, Retained, Via Natural or Artificial Opening

PCS Root Ops 27F

Comments: 

  • Extraction is defined as “Pulling or stripping out or off all or a portion of a body part by the use of force.”
  • This is a good example of when it is better to go directly to the tables rather than rely on the Index. There is nothing under the main term, Dilation. If you go to curettage, you are instructed to see Extraction or Excision. Practice some problems by going to the tables rather than rely solely on the Index. I realize that I have given you instructions in almost all the coding problems to go to the Index first. As you develop a comfort level with ICD-10-PCS, try to use the tables rather than just the Index.

 

We will continue our discussion of the Obstetrics section this week. As promised, I will give you some coding problems to do, but no discussion of guidelines. You should be able to successfully work these problem based on last week’s discussion. Because this is a holiday week and many of us still have last-minute shopping to do, I am only giving you three problems.

 

Coding problems for this week:

  1. Manually assisted delivery.
  2. Fetal spinal tap, percutaneous.
  3. Laparoscopic total removal of tubal pregnancy.

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

Answer Key:

  1. 10E0XZZ
  2. 10903ZA
  3. 10T24ZZ

 

Problem #1, Manually assisted delivery.

To Locate:  PCS Index > Delivery > Products of Conception > 10E0XZZ > That was easy, but as you all know, I still want you to locate table 10E and verify that the code given in the Index is correct:

Delivery of Products of Conception, External Approach

PCS Root Ops 26A

Comments:

  • Refer to the root operation, Delivery, for the fastest and most efficient was to locate the code and/or the correct table.
  • Review of Table 10E reveals that there is only one code in ICD-10-PCS for the root operation, Delivery.
  • Its fairly easy to determine the approach, External, because there were no incisions, no use of an endoscope.

 

Problem #2, Fetal spinal tap, percutaneous.

To Locate:  PCS Index > Drainage > Products of Conception > Fetal Cerebrospinal Fluid > 1090 > Locate table 109 and go across the row to finish building the code:

Drainage, Products of Conception, Fetal Cerebrospinal Fluid

PCS Root Ops 26B

Comments:

  • The correct body part for a fetal spinal tap is Products of Conception, which is the body part for all the Obstetrics codes.
  • There are several choices for the approach. Since a puncture was made, you know the correct choice is percutaneous. Since there is no mention of an endoscope, the approach, Percutaneous Endoscopic, is quickly ruled out.
  • The procedure is coded to the Obstetrics section because it was performed on the fetal spinal fluid. The fetus is specifically referenced as being a part of the Products of Conception.

 

Problem #3, Laparoscopic total removal of tubal pregnancy.

To Locate:  PCS Index > Resection > Products of Conception, Ectopic > 10T2 > locate table 10T and go across the row to finish building the code:

Resection Products of Conception, Ectopic, Percutaneous Endoscopic Approach

PCS Root Ops 26C 

Comments:

  • The Body Part of Products of Conception, Ectopic, should be assigned since the procedural statement indicated a tubal pregnancy.
  • Resection is the most appropriate Root Operation because the entire Products of Conception tissue was removed. Resection is defined as “Cutting out or off, without replacement, all of a body part.
  • The approach, Percutaneous Endoscopic, is assigned because the procedure was done laparoscopically after which instruments are inserted through the scope to carry out the desired procedure.

Last week we began a review of the Pregnancy section and we will continue with this topic for the next few sessions.  I want to make sure you understand the difference between root operations in the Med/Surg section versus the root operations in the Pregnancy section.

 

Coding problems for this week:

  1. Induction of labor by artificial rupture of membranes (AROM).
  2. Low cervical c-section.
  3. Vacuum breech delivery with episiotomy and repair.

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

Answer Key:

  1. 10907ZC
  2. 10D00Z1
  3. 10D07Z6, 0W8NXZZ, 0WQNXZZ

 

  • The Obstetrics section follows the same conventions as those in the Med/Surg section, with all 7 characters retaining the same meaning.
  • Guideline C.1 Products of Conception:  Procedures performed on the products of conception are coded to the Obstetrics section. Procedures performed on the pregnant female other than the products of conception are coded to the appropriate root operation in the Med/Surg section. For example, Amniocentesis is coded to the Products of Conception body part in the Obstetrics section. Repair of obstetric urethral laceration is coded to the Urethra body part in the Med/Surg section.
  • Guideline C.2 Procedures Following Delivery or Abortion:  Procedures performed following a delivery or abortion for curettage of the endometrium or evacuation of retained products of conception are all coded in the Obstetrics section, to the root operation Extraction and the body part, Products of Conception, Retained. A diagnostic or therapeutic D&C performed during times other than the postpartum or post-abortion period are all coded in the Med/Surg section, to the root operation Extraction and the body part, Endometrium.
  • Products of Conception refer to all components of pregnancy, including fetus, embryo, amnion, umbilical cord, and placenta.
  • Gestational age is irrelevant for PCS coding.
  • There are 12 root operations in the OB section, two of which are unique to the section, Abortion and Delivery. We discussed this last week but I want to expand on this guideline this week. Ten of the root operations are found in other sections of ICD-10-PCS, mostly the Med/Surg section. To further clarify this guideline, refer to the table below. The table contains commonly performed OB-related procedures that are coded in the Med/Surg rather than the Obstetrics section of ICD-10-PCS:

 

Root Ops - 25 Table 1

NOTE:  An episiotomy is a perineal surgical incision made just prior to delivery to enlarge the vaginal opening and ease delivery. The PCS code for the episiotomy is derived from the table 0W8; however, the episiotomy repair following delivery must also be coded separately from table 0WQ.

  • Qualifiers, character 7:  The Qualifier values are dependent on the root operation, approach, or body system. The 7th character provides detailed information for a variety of procedures:

 

Root Ops - 25 Table 2

Problem #1, Induction of labor by artificial rupture of membranes (AROM).

To Locate:  PCS Index > Rupture > Fluid Collection see Drainage > Drainage > Products of Conception > Amniotic Fluid > Therapeutic > 1090 > Locate table 109 and go across the row to finish building the code:

Drainage of Amniotic Fluid, Therapeutic from Products of Conception, Via Natural or Artificial Opening

Root Ops - 25A

Comments:

  • I went to “Rupture” first because it seemed like a logical choice. However, the most efficient way to locate the character value in the Index is to go to the Root Operation first; in this scenario, Drainage.
  • The procedure is coded to the Obstetrics section because it was performed on the amnion, which is specifically referenced as being a part of the Products of Conception.
  • The Qualifier C, Amniotic Fluid, Therapeutic, is assigned because the procedure was performed for therapeutic (as opposed to diagnostic) purposes.

 

 

Problem #2, Low cervical C-section.

To Locate:  PCS Index > Delivery > Cesarean see Extraction, Products of Conception > 10D0 > Locate table 10D0 and go across the row to finish building the code:

Extraction of Products of Conception, Low Cervical, Open Approach

Root Ops - 25B

Comments:

  • I went to “Delivery” to demonstrate why it is more efficient to go to the root operation first; in this case the root operation is Extraction.
  • The first character in an ICD-10-PCS Obstetrics code is always 1, Obstetrics.
  • There is only one valid character value for character 2 in an Obstetrics code, 0, Pregnancy.
  • Note that the root operation, “Extraction,” is from the Obstetrics section, not the Med/Surg section.

 

Problem #3, Vacuum breech delivery with episiotomy and repair. There are three final PCS codes for this problem.

To Locate breech delivery:  PCS Index > Extraction > Products of Conception > Vacuum > 10D07Z6. Pretty easy so far but you should still go to table 10D to verify that the procedure given in the Index is correct:

Extraction of Products of Conception, Vacuum, Via Natural or Artificial Opening

Root Ops - 25C 

We aren’t finished yet because we still have to account for the episiotomy.

To Locate Episiotomy:  PCS Index > Episiotomy > see Division, Perineum, Female > 0W8NXZZ. We got a break again, but I still want you to locate the table to verify that the code is correct:

Division of Female Perineum, External Approach

Root Ops - 25D  

Comments:

  • A few major changes:  We’ve gone from the Obstetrics section to the Med/Surg section; and from the Pregnancy Body System to the General Anatomical Regions Body System.
  • Division is defined as “Cutting into a body part without draining fluids and/or gases from the body part in order to separate or transect a body part.

 

One more procedure to go to wrap this up:  we have to account for the episiotomy repair.

To Locate Episiotomy Repair:  PCS Index > Repair > Perineum > Female > 0WQN > Locate table 0WQ and go across the row to finish building the code:

Repair Female Perineum, External Approach

Root Ops - 25E 

Comments:

  • External approach is defined as “Procedures performed directly on the skin or mucous membrane and procedures performed indirectly by the application of external force through the ski or mucous membrane.

I realize I gave you quite a bit to absorb this week but next week I’ll give you a break and we will practice what we’ve learned during this session. I’ll give you some more coding problems but no discussion of coding guidelines, etc.

This week we are going to review the Obstetrics section as it relates to abortions. Abortion is defined as artificially terminating a pregnancy. Procedures performed on the products of conception are coded to the Obstetrics section. Procedures performed on the pregnant female other than the products of conception are coded to the appropriate root operation in the Med/Surg section. For example, Amniocentesis is coded to the products of conception body part in the Obstetrics section. Repair of obstetric urethral laceration is coded to the Urethra body part in the Med/Surg section.

 

Coding Problems for this Week:

  1. Manually assisted spontaneous abortion.
  2. D&C following incomplete spontaneous abortion.
  3. Transvaginal abortion using vacuum aspiration technique.

 

 

 

 

 

 

Who We Are

 

 

 

 

 

Answer Key

  1. 10E0XZZ
  2. 10D17ZZ
  3. 10D07Z6

 

  • Character 1, Section:  The first character is always 1, regardless of whether it is an abortion or delivery of an infant.
  • Character 2, Body System:  There is only one valid character value for character 2; 0 for Pregnancy.
  • Character 3, Root Operation:  There are 12 Root Operation in the Obstetrics section, two of which are unique to this section:
    • Abortion (character value A):  Abortion is subdivided according to whether an additional device such as an abortifacient or laminaria is used or whether the procedure was performed by mechanical means. If either an abortifacient or laminaria is used, the Approach is Via Natural or Artificial Opening. All other abortion procedures are those done by mechanical means (the products of conception are physically removed using instrumentation) and the device value is Z, No Device.
    • Delivery (character value E):  Assisting the passage of the Products of Conception from the genital canal. This Root Operation applies only to manually-assisted vaginal deliveries.
  • Character 4, Body Part. There are three Body Part values:
    • Products of Conception
    • Products of Conception, Retained
    • Products of Conception, Ectopic

 

Problem#1, Manually assisted spontaneous abortion

To Locate:  PCS Index > Delivery > Products of Conception > 10E0XZZ > Locate table 10E and go across the row to verify that the procedure given in the Index is correct:

Delivery of Products of Conception, External Approach

Root Ops 24, A

 

Problem #2, D&C following incomplete spontaneous abortion.

To Locate:  PCS Index > Extraction > Products of Conception > Retained > 10D1 > Locate table 10D and go across the row to finish building the code:

Extraction of Products of Conception, Retained, Via Natural or Artificial Opening

Root Ops 24, B

 

Problem #3, Transvaginal abortion using vacuum aspiration technique.

To Locate:  PCS Index > Extraction > Products of Conception > Vacuum > 10D07Z6 > Locate table 10D and go across the row to verify that the code given in the Index is correct:

Abortion of Products of Conception Vacuum, Via Natural or Artificial Opening

Root Ops 24, C 

Last week we reviewed the Administration section. We will continue our review by coding two problems from this section:

 

Coding problems for this week:

  1. Open implantation of antimicrobial envelope with cardiac pacemaker placement (do not code pacemaker).
  2. Percutaneous irrigation of ankle joint.

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key:

  1. 3E0102A
  2. 3E1U38Z

 

Problem #1

To Locate:  PCS Index > Introduction > Subcutaneous Tissue > Anti-infective > 3E01 > locate table 3E0 and go across the row to finish building the code:

PCS Root Ops, 23 - A

This was a bit tricky. I went to Implantation and that didn’t work. Then I tried Insertion of device in and that didn’t work either. I finally tried Introduction and bingo!

 

Introduction: Putting ‘in’ or ‘on’ a therapeutic, diagnostic, nutritional, physiological, or prophylactic substance, except blood or blood products. Blood and blood products are coded to root operation ‘transfusion’.

 

CODING NOTE: ‘Body Part Value’ For the root operation Introduction, the body part value specifies where the procedure occurs and not necessarily the site where the substance introduced has an effect.

 

Examples:

- Antineoplastic/therapeutic agent infusion

- Transabdominal in-vitro fertilization

- Chemical pleurodesis with injection of tetracycline

- Insertion of rhBMP into bone

 

Problem #2, Percutaneous irrigation of ankle joint

To Locate:  PCS Index > Irrigation > Joint, Irrigating Substance > 3E1U38Z > Locate table 3E1 and go across the row to verify that the code is correct:

PCS Root Ops, 23 - B

Last week we reviewed the Placement section. Services performed in this section do not require puncture or incision and the approach is always external. This week we are going to continue our review by coding three more problems from the placement section.

 

Problems for this week:

  1. Sterile dressing to face wound.
  2. Cervical traction using a traction apparatus.
  3. Removal of stereotactic head frame.

 

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key:

  1. 2W21X4Z
  2. 2W62X0Z
  3. 2W50XYZ

 

Problem #1, Sterile dressing to face wound.

To Locate:  PCS Index > Dressing > Face > 2W21X4Z:  Locate table 2W2 and go across the row to verify that the code is correct:

Dressing of face using bandage

Root Opps 22, a

  • Any device that remains on the person following the procedure is coded. A bandage is considered a device.

 

Problem #2, Cervical traction using a traction apparatus

To Locate:  PCS Index > Traction > Neck > 2W62X > locate table 2W6 to verify character 6 and to assign 7th character:

Traction of neck using traction apparatus

Root Opps 22, b

  • Traction is defined as exerting a pulling force on a body region in a distal direction.

 

Problem #3, Removal of stereotactic head frame.

To Locate:  PCS Index > Removal > head > 2W50X > locate table 2W5 and go across the row to verify characters 4-5 and to assign characters 6-7:

Removal of other device on head

Root Opps 22, c 

  • “Other Device,” character 6 is assigned a value of Y because removal of a stereotactic head frame was not an option.

We have primarily focused on inpatient procedures in the Coding Tidbits. However, most hospitals require dual coding for outpatient procedures, both ICD and CPT. The Placement section includes several types of outpatient procedures, procedures which we will discuss this week.

  • Placement procedures involve services performed without making any incision or puncture.
  • The 7 characters that make up a PCS code in this section are almost the same as those in the Med/Surg section.
  • Character 1:  Always Placement
  • Character 2, Body System:  There are only 2 character values for the 2nd character:
    • Anatomical Regions such as head, right inguinal region, abdominal wall, etc.
    • Anatomical Orifices such as mouth, pharynx, ear, urethra, etc.
    • Character 3, Root Operation:  Compression, Dressing, Immobilization, Packing and Traction.
    • Character 4, Body Region:  There are 2 general types of Body Regions in the Placement section which correspond to the 2nd character Body System values:  W for Anatomical Regions or Y for Anatomical Orifices.
    • Character 5, Approach:  There is only one valid 5th character for Approach in the Placement section – X for External. No incision or puncture is made and the procedures are either performed on the skin or mucous membranes or by the use of force or external pressure.
    • Character 6, Device:  The Device character typically designates the material used in a placement procedure such as splint, cast, brace, etc.
    • Please note that at this time there are no valid characters for the 7th character filed for Placement procedures. Therefore, assign Z, No Qualifier, for all procedures.

 

Coding problems for this week:

  1. Insertion of nasal packing.
  2. Placement of pressure dressing on abdominal wall wound.
  3. Splint placement, right lower leg.

 

 

 

 

Who We Are

 

 

 

 

 

Answer Key:

  1. 2Y41X5Z
  2. 2W13X6Z
  3. 2W3LX1Z

 

Problem #1, Insertion of nasal packing.

To Locate:  PCS Index > Packing > Nasal > 2Y41X5Z > Locate table 2Y4 to verify that the code given in the Index is correct:

Packing of nasal region using packing material

PCS Root Ops, 21 - A

 

 

Problem #2, Placement of pressure dressing on abdominal wall wound.

To Locate:  PCS Index > Abdominal Wall > 2W13X > locate table 2W1 and go across the row to complete the code:

Compression of abdominal wall using pressure dressing

PCS Root Ops, 21 - B

 

 

Problem #3, Splint placement, right lower leg.

To Locate:  PCS Index > Immobilization > Leg > Lower > Right > 2W3QX > Locate table 2W3 to complete the code:

Immobilization of right lower extremity using splint

PCS Root Ops, 21 - C

 

From the Blog

ICD-10-PCS, Root Operations – Part 30, Procedures: Question & Answer

This week we will continue to focus on procedures in the Administration section. If you need to reviread more