ICD-10-CM/PCS – Part 55: Question & Answer

ICD-10-CM/PCS – Part 55: Question & Answer

The clock is ticking – we are on countdown for ICD-10. Very few of us are ICD-10 coding experts, but with determination and dedication, we will all get there, some of us sooner than later. Several coders intend to retire come October. Please don’t let ICD-10 discourage you. Everyone faces a challenge learning how to code ICD-10 procedures, a complete change from the ICD-9 procedure code set. On a lighter note, the ICD-10-CM diagnostic codes follow similar publication layout/format as ICD-9-CM. There, of course, have been changes to the structure of the ICD-10-CM codes, but none that are all that difficult to learn. Remember this – inch by inch, it’s a cinch. We are all in this together.

 

There are a few issues we would like to point out for our new readers. Most of you know from previous Tidbits that you are given problems that require assignment of both diagnosis and procedure codes. We will continue to offer this feature for all future Tidbits. The breakdown of diagnostic codes, a relatively new feature, applies only to the PDx. Also, the sequencing of directions for using the tables will now be placed immediately under the principal procedure table rather than placing it as the last item.

 

Before coding this week’s problem, please note the following: Subsequent encounter for open and closed fractures: used for encounters after active fracture treatment has been completed and the patient is receiving routine care during the healing or recovery period.

 

Problem for this week:

Several months ago the patient, a 55-year-old woman, fell off a ladder and fractured her left hip. She sustained a closed fracture of the femoral shaft for which she underwent surgery. During her recovery period, she saw her physician complaining of pain in her hip. After x-rays were taken, the physician diagnosed her with non-union of the fracture. Her treatment consisted of a percutaneous insertion of a bone growth stimulator. Do not assign E codes with the exception of the external cause of the fall.

 

 

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

 

Answer Key:

  1. S72.302K: Unspecified fracture of shaft of left femur, subsequent encounter for closed fracture with non-union
  2. W11.XXXD: Fall on and from ladder, subsequent encounter
  3. 0QHY3MZ: Insertion of bone growth stimulator into lower bone, percutaneous approach

 

Breakdown of S72.302K:

S72 = Fracture of femur

S72.3 = Fracture of shaft of femur

S72.30 = Unspecified fracture of shaft of femur

S72.302 = Unspecified fracture of shaft of left femur

S72.302K = Unspecified fracture of shaft of left femur, subsequent encounter for closed fracture with non-union

 To locate S72.302K: Disease Index > Fracture, traumatic > femur, femoral > shaft > S72.30- > Tabular to complete code > left > S72.302 > 7th character required > K > S72.302K

Comments for S72.302K:

  • Under S72, Fracture of femur, there is a box containing all the 7th character possibilities.
  • K is the 7th character – subsequent encounter for closed fracture with nonunion.
  • A dash following a character as in S72.30- indicates that the code is incomplete and you must refer to the Tabular to complete the code.
  • Nonunion means the fracture has failed to show evidence of healing and there is still separation of bony structures involved in the fracture.

 

To locate W11.XXXD: External Causes Index > Fall, falling > from, off, out of > ladder > W11 > go to Tabular to complete the code > see the box immediately below W11 to select the appropriate encounter > D, subsequent encounter for a code of W11.XXXD.

Comments for W11.XXXD:

  • This is a subsequent encounter as indicated in the diagnostic statement.
  • ICD-10-CM codes are always up to 7 digits in length. How do you account for the 3 Xs? Xs serve as placeholders in ICD-10-CM.
  • Certain ICD-10-CM categories have applicable 7th characters and is required for all codes within the category, or as the notes in the Tabular List instruct. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters. In our scenario we have 3 Xs to fill in the empty characters.

 

To locate 0QHY3MZ: PCS Index > Insertion of device in > Bone > Femoral Shaft > Left > 0QHY > locate table 0QH and go across the row to finish building the code:

Insertion of Bone Growth Stimulator into Lower Bone, Percutaneous Approach

PCS Root Ops 55

Comments:

  • Insertion is defined as “Putting in a non-biological appliance that monitors, assists, performs or prevents a physiological function but does not physically take the place of a body part.”
  • This device (BGS) stimulates the natural healing process by sending low-level pulses of electromagnetic energy to the injury or fusion site.
  • This problem can be a bit tricky. When indexing Insertion of device in, there is also a subterm for Femoral Shaft (0QH9.) When reviewing the table, Femoral Shaft, Left (9) is not an option for the bone growth stimulator (BGS). In the table row for BGS (M) is the only 6th character device available under the body part for the Lower Bone (Y).
  • The diaphragm is used as the frame of reference for body systems classified as upper bones or lower bones. In our scenario, the femur is below the diaphragm and considered to be the part of the Lower Bones.
  • If you look at Devices in the 2nd row of table 0QH, it doesn’t include a choice of BGS. The 3rd row of table 0QH does list BGS; therefore, you have no options to use any row in that table except for row #3.
  • Guideline 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.

Directions for Locating the Codes by Going Directly to the Tables

Insertion of Bone Growth Stimulator

0QHY3MZ

  1. Step #1 is to locate the correct section in your PCS coding book. You know that surgery was performed, so the most logical selection is the Med/Surg section. The majority of procedures are found here. The first character in the Med/Surg section is always 0.
  2. Step 2: Determine the correct body system. The body system is Lower Bones. Don’t look for a section entitled Musculoskeletal System. ICD-10-PCS uses Upper Bones and Lower Bones instead of the broader Musculoskeletal System anatomy (muscles, tendons, bursae and ligaments, head and facial bones, upper and lower joints, upper and lower bones, and in our scenario, lower bones.) We have identified the first two characters, 0Q.
  3. Step 3: Determine the root operation. You know you have to be in a table that starts with 0Q. You should also know that the root operations are listed alphabetically. Simply go through all the tables that start with 0Q and look for the root operation, Insertion. We now have the first three characters, 0QH, which puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives the section, Med/Surg; the body system, Lower Bones; the root operation, Insertion.
  4. Step 4: Identify the body part to determine the 4th character value. The body part, left femoral shaft, should relate to the root operation, Insertion, because it was the femoral shaft that received the Bone Growth Stimulator. However, as we previously discussed, since the device, bone growth stimulator is not an option in row #2, you must use row #3 to capture Bone Growth Stimulator. Row #3 lists only one body part, Lower Bone. We now have 4 character values, 0QHY.
  5. Step 5: Determine the Approach. No guesswork regarding the approach, as our diagnostic statement clearly states that the procedure was done percutaneously. We should now have 5 characters, 0QHY3.
  6. Step 6: Determine whether or not a device was left in the patient postoperatively. We know that there was a device left in place, the Bone Growth Stimulator. We should now have 6 characters, 0QHY3M.
  7. Step 7: There is no qualifier, so we should now have our code, 0QHY3MZ. Z functions as a placeholder in ICD-10-PCS. Z is to PCS what X is to ICD-10-CM.

Hello there, Busters. In a few more months we will all be coding from the ICD-10 code set, ready or not. We hope these weekly tidbits have been helpful. We’re trying to do our best to help you prepare. This week we are giving you two problems to solve related to the prostate. It is a good exercise because when coding, you will be able to compare the similarities and differences between the 2 coding problems.

There are a few changes we are going to point out for our new readers. For the past few weeks we have given you coding problems that require assignment of both diagnoses and procedures. With respect to the breakdown of diagnostic codes, a new feature, we will only do that for the PDx. However, this week’s PDx only has 3 digits, so there is nothing to break down. This week you will be given 2 problems to solve from Diseases of the Genitourinary System, Chapter 14. Also, directions for locating the codes by using the tables only applies to the principal procedure and for this week, it will be for the second problem, and will be the last item discussed.

Problems for the week:

1.) A 55-year-old man was anuric and diagnosed with prostate cancer for which he underwent an open radical retropubic prostatectomy.

2.) A resident from an assisted living home complained of a sensation of incomplete bladder emptying, and was immediately taken to surgery where a transurethral endoscopic laser ablation of the prostate was done upon admission to an acute care hospital. Final diagnosis is BPH.

 

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

Answer Key

1.) C61 = Malignant neoplasm of the prostate

R34 = Anuria and oliguria

0VT00ZZ = Radical retropubic prostatectomy, open

 

2.) N40.1 = Benign Prostatic Hypertrophy (enlarged prostate) with lower urinary tract symptoms (LUTS)

R39.14 = Feeling of incomplete bladder emptying

0V508ZZ = Destruction of prostate, via natural or artificial opening, endoscopic

 

Problem #1, To Locate C61: Disease Index > Neoplasm Table > 1st column, Malignant Primary > prostate > C61 > verify in Tabular.

To Locate R34: Disease Index > Anuria > R34 > verify in Tabular.

Comments:

  • Codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis. The definitive diagnosis should be sequenced before the symptom code.
  • In this case, not every patient who has prostate cancer routinely has the symptoms of anuria. Hence, anuria is coded, and sequenced after C61.

To locate 0VT00ZZ: PCS Index > Prostatectomy > see Resection, Prostate > 0VT0 > locate table 0VT and go across the row to finish building the code and also verify that the 4th character is correct:

Resection of Prostate, Open Approach

PCS Root Ops 54AComments:

  • Resection is defined as “Cutting out or off, without replacement, all of a body part.”
  • The Index gives you a choice of excision or resection. We know the entire prostate was removed because in our diagnostic statement it states that the prostatectomy was radical.

 

Problem #2, To locate N40.1/R39.14: Disease Index > Hypertrophy, hypertrophic > prostate > see Enlargement, enlarged, prostate > with lower urinary tract symptoms (LUTS) > N40.1 > Verify in tabular > Instructional Note: Use additional code for associated symptoms, when specified > incomplete bladder emptying > R39.14 > Verify both codes in Tabular.

Comments, N40.1/R39.14:

  • 1 is a combination code that includes both the enlarged prostate, Benign Prostatic Hypertrophy (BPH) and the lower urinary tract symptom of incomplete bladder emptying.
  • In the Index in red font there is a list of symptoms associated with LUTS. Select the most appropriate symptom.

 

To locate 0V508ZZ: PCS Index > Destruction > Prostate > 0V50 > locate table 0V5 and go across the row to finish building the code. Also verify that the 4th character value is correct:

Destruction of Prostate, Via Natural or Artificial Opening Endoscopic

PCS Root Ops 54B

Comments:

  • In both instances, the prostate was removed/destroyed but the surgical method employed different techniques.
  • In the first example, the prostate was cut out (resected) via an open approach,
  • In the 2nd example the prostate was destroyed via laser ablation.
  • In the PCS Index, the main term ablation sends you to destruction. Think of ablation and destruction as synonymous terms.
  • Destruction is defined as “Physical eradication of all or a portion of a body part by the direct use of energy, force or a destructive agent.” In our example laser was the destructive agent.

 

Directions for Locating the Codes by Going Directly to the Tables

Resection of prostate, open approach

0VT00ZZ

  1. Step #1 is to locate the correct section in your PCS coding book. You know that surgery was performed, so the most logical selection is the Med/Surg section. The majority of procedures are in the Med/Surg section. The first character in the Med/Surg section is always 0.
  2. Step 2: Determine the correct Body System. Since the body part is the prostate, it is only logical that the Body System is the Male Reproductive System. We have identified the first two characters, 0V.
  3. Step 3: Determine the root operation. You know you have to be in a table that starts with 0V. You should also know that the root operations are listed alphabetically. Simply go through the all the tables that start with 0V and look for the root operation, resection. We now have the first three characters, 0VT, which puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives the section, Med/Surg; the body system, Male Reproductive; the root operation, Resection.
  4. Step 4: Identify the Body Part to determine the 4th character value. The Body Part, prostate, should relate to the root operation, Resection, because it was the prostate that was resected. We now have 4 character values 0VT0.
  5. Step 5: Determine the Approach. No guesswork regarding the approach, as our diagnostic statement clearly states that the procedure was done via an open approach. We should now have 5 characters, 0VT00.
  6. Step 6: Determine whether or not a device was left in the patient postoperatively. No device was left in place, so assign Z, the placeholder, as the character value. We should now have 6 characters, 0VT00Z.
  7. Step 7: There is no qualifier, so we should now have our code, 0VT00ZZ. Z functions as a placeholder in ICD-10-PCS. In other words, Z is to PCS what X is to ICD-10-CM.

For the past few weeks we have given you coding problems that require assignment of both diagnoses and procedures. With respect to the breakdown of diagnostic codes, a new feature, we will only do that for the PDx. This week you will be given a problem to solve from Perinatal Conditions, Chapter 16. Also, directions for locating the codes by using the tables only applies to the principal procedure and it will always be the last item discussed.

 

Problem for this week: A one-day-old 2,200-gram female infant was born prematurely at 34 weeks gestation. She was transferred from another hospital for evaluation of a congenital diaphragmatic hernia. Just before transfer, intubation was necessitated by some respiratory distress. The ventilator support was continued for 3 days. When she was stabilized, the diaphragmatic hernia was repaired via an abdominal approach, and the hernia sac was excised.

 

 

 

 

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

 

Answer Key:

  1. Q79.0:   Congenital diaphragmatic hernia
  2. P07.18: Other low birth weight newborn, 2000-2499 grams
  3. P07.37: Other preterm newborn, gestational age 34 completed weeks
  4. P22.9:   Respiratory distress of newborn, unspecified
  5. 0WQF0ZZ: Repair abdominal wall, open approach
  6. 5A1945Z: Respiratory ventilation, 24-96 consecutive hours

 

Breakdown of PDx, Congenital Diaphragmatic Hernia:

  • Q79 = Congenital malformations of musculoskeletal system, not elsewhere classified
  • Q79.0 = Congenital diaphragmatic hernia

 

To locate Q79.0: Disease Index > Hernia > diaphragm, diaphragmatic > congenital > Q79.0 >

verify in Tabular.

To Locate P07.18: Disease Index > Low > birthweight > with weight of > 2000-2499 grams > P07.18 > Verify in Tabular.

To Locate P07.37: Disease Index > Preterm > newborn > gestational age > 34 completed weeks > P07.37 > Verify in Tabular.

To Locate P22.9: Disease Index > Distress > respiratory > newborn > P22.9 > Verify in
Tabular.

 

General Comments:

  • No code from category Z38 (liveborn infants) is assigned. The patient wasn’t born in this hospital; rather, she was transferred from another hospital when she was one day old. Codes from category 38 is to be used for the initial birth record only.
  • If you located gestational age (weeks), from the main term, Pregnancy, and then to the sub-term “weeks of gestation,” you would be directed to a code from catetgory Z3A, which is only to be used on the maternal records only. Code Z3A are not to be coded with codes on the liveborn infant record.
  • When both birth weight and gestational age are available, both should be coded with birth weight sequenced before gestational age.
  • Preterm consists of 28 weeks or more but less than 37 completed weeks (196 completed days but less than 259 completed days) of gestation.

 

To Locate 0WQF0ZZ: PCS Index > Herniorrhaphy > see Repair > Anatomical Regions > General > 0WQ > Locate table 0WQ and go across the row to finish building the code:

Repair Abdominal Wall, Open Approach

PCS Root Ops 53A

Comments:

  • Repair is defined as “Restoring, to the extent possible, a body part to its normal anatomic structure and function.”
  • General Anatomical Regions, 2nd character, includes the general body cavities (spaces that contain organs and other structures.) Included in the general regions are the larger surface areas of the body such as the chest wall, abdominal wall, and upper and lower back.
  • One of the larger surface areas of the body is the abdominal wall. Using an open approach, the surgeon was able to access the diaphragmatic hernia, after which the hernia was excised.
  • You may be questioning why Device, the 6th character wasn’t coded. If there is a device, the device character is always specified and indicates the device placed during the procedure.
  • Intubation is not coded because it was performed at the other hospital.

 

To Locate 5A1945Z: PCS Index > Performance > Respiratory > 24-96 Consecutive hours > 5A1945Z

Respiratory Ventilation, 24-96 hours

PCS Root Ops 53B

Comments

  • We were tempted to go to the main term Ventilation but then I remembered that it is faster and easier to go directly to the root operation, Performance.
  • Performance is defined as “Completely taking over a physiological function by extracorporeal means.”
  • The root operation is Performance because the machine has taken over the patient’s cardiac function during the procedure.
  • Note that the 5th character, Approach and Device (Med/Surg section), have been replaced by Duration and Function in the Extracorporeal Assistance and Performance section, respectively.
  • This was an easy one to code because the Index gives you the answer.
  • There are 31 Body Systems under Physiological Systems such as Respiratory, Circulatory, GI System Skin and Breast, et al. The Extracorporeal Assistance and Performance section is included here.

 

Directions for Locating the Codes by Going Directly to the Tables

Herniorrhaphy of Abdominal wall

0WQF0ZZ

 

  1. Step #1 is to locate the correct section in your PCS coding book. The majority of procedures are in the Med/Surg section. The first character in the Med/Surg section is always 0.
  2. Step 2: Determine the correct Body System – General Anatomical Regions. Since you are dealing with Anatomical Regions and since you know that the abdominal wall is part of Anatomical Regions, it should be easy to determine the body system. Thus far, we have identified the first two characters, 0W.
  3. Step 3: Determine the root operation. You know you have to be in a table that starts with 0W. From this point I would look for the root operation, Repair, by scanning through the tables. The root operations are listed alphabetically, so it shouldn’t be hard to find the correct one. We now have the first three characters, 0WQ, which puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives the section, Med/Surg; the body system, Anatomical Regions, General; the root operation, Repair.
  4. Step 4: Identify the Body Part to determine the 4th character value. The Body Part, Abdominal Wall, should relate to the root operation, Repair, because it was the diaphragmatic hernia that was repaired. We now have 4 character values 0WQF.
  5. Step 5: Determine the Approach. No guesswork regarding the approach, as our diagnostic statement clearly states that the procedure was done via an abdominal approach, which is an open approach. We should now have 5 characters, 0WQF0.
  6. Step 6: Determine whether or not a device was left in the patient postoperatively. No device was left in place, so assign Z, the placeholder, as the character value. We should now have 6 characters, 0WQF0Z.
  7. Step 7: There is no qualifier, so we should now have our code, 0WQF0ZZ. Z functions as a placeholder in ICD-10-PCS. In other words, Z is to PCS what X is to ICD-10-CM.

We will continue to give you problems that include both diagnoses and procedures. This week we are focusing on a problem from the Diseases of the Musculoskeletal System and Connective Tissue, Chapter 13.

 

Problem for the week: After falling from a ladder while working on his house, the patient was brought to the ER where he was admitted. He sustained contusions of the scalp and face and an open type I intertrochanteric fracture of the right femur. The fracture site was excisionally debrided, and an open reduction with internal fixation was carried out. Don’t assign E codes except for the external cause of the injury.

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

Answer Key:

  • S72.141B: Displaced intertrochanteric fracture of the right femur, initial encounter, for open fracture type I or II
  • S00.03xA: Contusion of scalp
  • S00.83xA: Contusion of other part of head
  • W11.xxxA: Fall from ladder
  • 0QS604Z: Open reduction with internal fixation (reposition right upper femur)
  • 0QB60ZZ: Debridement (root operation “Excision”)

 

Breakdown of S72.141B

S72 = Fracture of Femur

S72.1 = Pertrochanteric fracture

S72.14 = Intertrochanteric fracture of femur

S72.141B = Displaced intertrochanteric fracture of right femur; initial encounter, for open fracture type I or II

 

To locate S00.03xA: Alphabetic Index > Contusion > scalp > S00.03 > Tabular to obtain remaining digits (all ICD-10-CM codes are 7 digits long) > 7th digit required > the next 6th character is x, placeholder in ICD-10-CM > S00.03x > S00.03xA (A is initial encounter.)

To Locate S00.83xA: Alpha Index > Contusion > face NEC > S00.83 > Go to the Tabular to assign remaining digits so you come out with a total of 7 digits > S00.83x > (x is the placeholder for ICD-10-CM, just as Z is the placeholder for procedures) > S00.83xA (A is for initial encounter.)

To Locate W11.xxxA: Index to External Causes > Fall, falling > from, off, out of > ladder > W11 > Tabular: 3rd, 4th, and 5th character, placeholder is x > W11.xxx > 7th character is the A-initial encounter > W11.xxxA.

To Locate 0QS604Z > PCS Index > Reposition > Femur > Upper > Right > 0QS6 > locate table 0QS and go across the row to finish building the code, remembering to verify the 4th character:

 

Reposition Right Upper Femur with Internal Fixation Device, Open Approach

PCS Root Ops 52A

Comments:

  • PCS divides the bones into upper and lower. Anything above the diaphragm is considered an upper bone and anything below the diaphragm would be considered a lower bone.
  • There are some new terms in ICD-10-PCS and this is a good example. Reposition replaces Reduction.
  • Reposition is defined as “Moving to another location or other suitable location all or a portion of a body part.
  • An intertrochanteric fracture involves the proximal femur, which consists of the femoral head, the femoral neck, and the trochanteric region (including the greater and lesser trochanters.
  • The bone was fixated with an internal fixation device. A device is used only to specify devices that remain after the procedure is completed

 

To Locate 0QB60ZZ: PCS Index > Debridement > Excisional > see Excision > Femur > Upper > Right > 0QB6 > locate table 0QB and go across the row to finish building the code, and remember to verify the 4th character:

Excision of Right Upper Femur, Open Approach

PCS Root Ops 52B

Comments:

  • Before setting the bone, some debridement of the femur was required.
  • Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.
  • Excision is defined as ‘Cutting out or off, without replacement, a portion of a body part.” Please note that the main difference between these 2 root operations is that in Replacement, it always involves a device. In an excision procedure, which is the case in our scenario, the dead or damaged tissue is not replaced.
  • Upper bones versus lower bones applies to this part of the problem, e.g., above/below the diaphragm.
  • If you do an alpha search for all root operations in the 0QB tables, you will see that debridement is not included.

Directions for Locating the Codes by Going Directly to the Tables

REPOSITION OF FEMUR WITH ORIF

0QS604Z

  1. Step #1 is to locate the correct section in your PCS coding book. The majority of procedures are in the Med/Surg section. The first character in the Med/Surg section is always 0.
  2. Step 2: Determine the correct Body System – lower bones. Since you are dealing with the Musculoskeletal System (MS) and since you know that the femur is part of the MS System, it should be easy to determine the body system. PCS divides the bones into upper and lower. Thus far, we have identified the first two characters, 0Q.
  3. Step 3: Determine the root operation. You know you have to be in a table that starts with 0Q. The root operations are listed alphabetically, so it shouldn’t be hard to find the correct root operation. Our root operation is Reposition. We now have the first three characters, 0QS, which puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives the section, Med/Surg; the body system, Lower Bones; the root operation, Reposition.
  4. Step 4: Identify the Body Part to determine the 4th character value. The Body Part, upper right femur, should relate to the root operation, Reposition, because it was the femur that was repositioned. We now have 4 character values 0QS6.
  5. Step 5: Determine the Approach. No guesswork regarding the approach, as our diagnostic statement clearly states that the procedure was done via an open approach. We should now have 5 characters, 0QS60.
  6. Step 6: Determine whether or not a device was left in the patient postoperatively. This procedure an ORIF (open “reposition” with internal fixation) was carried out. This clearly indicates that a device was left in place. We should now have 6 characters, 0QS604.
  7. Step 7: There is no qualifier, so we now have our code of 0QS604Z. Z functions as a placeholder in ICD-10-PCS.

For the past few weeks we have given you coding problems that require assignment of both diagnoses and procedures. With respect to the breakdown of diagnostic codes, a new feature, we will only do that for the PDx. This week you will be given a problem to solve from the Digestive System, Chapter 11. As a reminder, directions for coding directly from the tables will always be the last item and it only gives directions for the principal procedure.

 

Problem for the week: A patient with a 20-year history of severe complicated ulcerative colitis was admitted for surgical intervention. A total abdominal colectomy with ileostomy was performed via open approach.

 

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

 

 

Answer Key:

K51.919: Ulcerative colitis, unspecified with unspecified complications

0DTE0ZZ: Resection of large intestine, open approach

0D1B0Z4: Bypass ileum to cutaneous, open approach

 

Breakdown of K51.919:

K51 = Ulcerative colitis

K51.9 = Ulcerative colitis, unspecified

K51.91 = Ulcerative colitis, unspecified, with complications

K51.919 = Ulcerative colitis, unspecified with other complication

 

To Locate K51.919: Colitis > ulcerative > with > complications > K51.919 > verify in

Tabular.

To Locate 0TDE0ZZ: Resection > Intestine > Large > 0DTE > locate table 0DT and go across the row to finish the code, verifying the 4th character:

Resection of Large Intestine, Open Approach

PCS Root Ops 51A

Comments:

  • Resection versus excision: Resection is cutting out or off without replacement, all of a body part. The entire large intestine was removed.
  • Excision is cutting out of or off, without replacement a portion of a body part. If only a portion of the large intestine had been removed, you would code it to excision.
  • Å colectomy neither cures nor eliminates Ulcerative Colitis/Crohn’s disease; instead it removes the entire diseased large intestine.
  • Ileostomy is a surgical opening (stoma) constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin and to the surgical procedure which creates this opening. Intestinal waste passes out of the ileostomy and is collected in an artificial external pouching system, which is adhered to the skin.

 

To Locate 0D1B0Z4: PCS Index > Bypass > Ileum > 0D1B > locate table 0D1 and go across the row to finish building the code, and also verify that the 4th character of Ileum is correct:

Bypass Ileum to Cutaneous, Open Approach

PCS Root Ops 51B

Comments:

  • Bypass is defined as “Altering the route of passage of the contents of a tubular body part.”
  • There are three methods and more specifically, they are:
    • Rerouting contents from one area of a body part to a downstream area in the normal route;
    • Rerouting the contents to a similar route and body part, or to an abnormal route and a dissimilar body part. Includes one or more anastomoses, with or without the use of a device.
    • Guideline B3.6a indicates that the “fourth character body part specifies the body part bypassed from, and the qualifier specifies the body part bypassed to.” In this scenario, the ileum is redirected to the external cutaneous part of the body. In other words, the 4th character, ileum, is the origin of the bypass, and the 7th character, cutaneous, is the destination of the bypass.

 

 

Directions for Locating the Codes by Going Directly to the Tables

0DTE0ZZ

  1. Step #1 is to locate the correct section in your PCS coding book. The majority of procedures are in the Med/Surg section. The first character in the Med/Surg section is always 0.
  2. Step 2: Determine the correct Body System – Gastrointestinal System. Since you are dealing with the large intestine and since you know that the large intestine is part of the GI System, it should be easy to make this determination. Thus far, we have identified the first two characters, 0D.
  3. Step 3: Determine the root operation. You know you have to be in a table that starts with 0D. From this point I would look for the root operation, Resection, by scanning through the tables. The root operations are listed alphabetically, so it shouldn’t be hard to find the correct root operation. Our root operation is Resection. We now have the first three characters, 0DT, which puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives the section, Med/Surg; the body system, Gastrointestinal System; the root operation, Resection.
  4. Step 4: Identify the Body Part to determine the 4th character value. The Body Part, large intestine, should relate to the root operation, Resection. We now have 4 character values 0DTE.
  5. Step 5: Determine the Approach. No guesswork regarding the approach, as our diagnostic statement clearly states that the procedure was done via an open approach. We should now have 5 characters, 0DTE0.
  6. Step 6: Determine whether or not a device was left in the patient postoperatively. In the case of our procedure, there was no devices left after surgery, so we should now have 6 characters, 0DTE0Z.
  7. Step 7: There is no qualifier, so we now have our code of 0DTE0ZZ. Z functions as a placeholder in ICD-10-PCS.

As we have stated over the past two weeks, we are going to give you problems that include assignment of both diagnoses and procedure codes. This week we will focus on a problem from the Circulatory System, Chapter 9.

Problem for this week: Patient has severe aortic valve stenosis and left ventricular hypertrophy. The aortic valve was replaced with a prosthesis, after which the patient was weaned from the cardiopulmonary bypass machine. To access the valve, a median sternotomy was done.

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

 

Answers for this week:

  • I35.0: Nonrheumatic aortic (valve) stenosis
  • I51.7: Cardiomegaly
  • 02RF0JZ: Replacement of aortic (valve) stenosis
  • 5A1221Z: Performance of cardiac output, continuous

 

Breakdown of diagnostic code, I35.0

I35 = Non-rheumatic aortic valve disorders

I35.0 = Non-rheumatic aortic (valve) stenosis 

To Locate I35.0: Alphabetic Index > Stenosis, stenotic > aortic valve > I35.0 > verify in Tabular.

COMMENTS:

  • This procedure is used when the patient’s aortic valve is failing.
  • The failing aortic valve is replaced with an artificial heart valve.
  • Don’t be mislead by the word “replacement.” The patient’s original valve was replaced by a prosthetic valve; it is not a prosthetic valve being replaced by another prosthetic valve.

To Locate I51.7: Cardiomegaly > see also Hypertrophy, cardiac > I51.7.

To Locate 02RF0JZ: PCS Index > Replacement > Valve > Aortic > 02RF > Locate table 02R and go across the row to finish building the code as well as verify that the 4th digit of F is correct:

Replacement of Aortic Valve with Synthetic Substitute, Open Approach

PCS Root Ops 50A

Comments:

  • Replacement is defined as “Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part.”
  • Once the pericardium has been opened, the patient is put on a cardiopulmonary bypass machine.
  • A cut is made in the aorta and a cross-clamp applied. The diseased aortic valve is then removed and a mechanical or tissue valve is put in its place.

To Locate 5A1221Z, Extracorporeal Circulation: PCS Index > There is no listing in the Index for Extracorporeal Circulation. In the Table of Contents, look for Extracorporeal Assistance and Performance found under “ICD-10 Tables” > go to the correct page (p. #440 for the Optum 2015 edition) and there you will find table 5A1 > go across the row to finish building the code:

Performance of Cardiac Output, Continuous

PCS Root Ops 50B

Comments:

  • Extracorporeal Circulation is classified to the Extracorporeal Assistance and Performance section.
  • The root operation is Performance because the machine has taken over the patient’s cardiac function during the procedure.
  • The machine takes over the task of breathing for the patient and pumping their blood around while the surgeon replaces the heart valve.
  • Note that the 5th character, Approach and Device (Med/Surg section), have been replaced by Duration and Function in the Extracorporeal Assistance and Performance section, respectively.

 

Locating the Code(s) by Going Directly to the Tables

Directions for Aortic Valve Replacement 

02RF0JZ

  1. Step #1 is to locate the correct section in your PCS coding book. The majority of procedures are in the Med/Surg section. The first character in the Med/Surg section is always 0.
  2. Step 2: Determine the correct Body System – Heart and Great Vessels. You are dealing with a heart valve, so it should be easy to determine the correct section. Thus far, we have identified the first two characters, 02.
  3. Step 3: Determine the root operation. You know you have to be in a table that starts with 02. From that point I would look for the root operation, Replacement, by scanning through the tables. The root operations are listed alphabetically, so it shouldn’t be hard to find the correct root operation. Our root operation is Replacement. We now have the first three characters, 02R. And this puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives the section, Med/Surg; the body system, Heart and Great Vessels; the root operation, Replacement.
  4. Step 4: Identify the Body Part to determine the 4th character value. The Body Part, aortic valve, should relate to the root operation, Replacement. We now have 4 character values 02RF.
  5. Step 5: Determine the Approach. A sternotomy was made to access the valve. This is obviously an open approach. We should now have 5 characters, 02RF0.
  6. Step 6: Determine whether or not a device was left in the patient postoperatively. A synthetic valve replaced the diseased valve. A synthetic valve isn’t a device, per se, but it is a non-organic substitute and will function as the new valve. We should now have 6 characters, 02RF0J.
  7. Step 7: There is no qualifier, so we now have our code of 02RF0JZ. Z functions as a placeholder in ICD-10-PCS.

We will continue to focus on problems that include assignment of both diagnostic/procedural codes. This week we are working a problem from the Endocrine, Nutritional and Metabolic Diseases chapter, Chapter 4.

Problem for this week: A patient was admitted for severe malnutrition and hematuria secondary to amyotrophic lateral sclerosis. Due to her malnutrition, a nasogastric feeding tube was placed under fluoroscopy.

 

 

 

 

 

Who We Are

 

 

 

 

 

 

Answer Key:

  • E43: Unspecified severe protein-calorie malnutrition
  • G12.21: Amyotrophic lateral sclerosis (ALS)
  • R31.9: Hematuria, unspecified
  • 3E0G36Z: Introduction of nutritional substance into upper GI, percutaneous approach

 

To Locate Severe protein-calorie malnutrition: Alphabetic Index > Malnutrition > severe (protein energy) > E43 > Go to the Tabular to verify the code. While you’re in training and using your coding books, be aware of why its important to refer to the Tabular before going on to the next code because the Tabular is where you’ll find instructional notes, Includes/Excludes, et al.

Comments

  • Admission was necessitated by malnutrition, not the underlying ALS. Therefore, severe malnutrition is the condition requiring placement of a feeding tube, and it is the PDx.

To Locate ALS: Alphabetic Index >Amyotrophia > lateral sclerosis> G12.21 > verify in Tabular.

To Locate hematuria: Alphabetic Index >Hematuria > R31.9 > go to Tabular to verify. NEVER code from the Index.

To Locate nasogastric feeding tube: PCS Index > Introduction of substance in or on > Gastrointestinal tract > Upper > Nutritional substance > 3E0G > locate table 3E0 and then go across the row to finish building the code:

Introduction of Nutritional Substance Into Upper GI, Percutaneous Approach

PCS Root Op 49

Comments:

  • The Administration section includes services such as injections, infusions, and transfusions.
  • There are 3 root operations in the Administration section, and they are classified according to the broad category of substance administered. In our scenario, a nutritional substance was “Introduced,” resulting in a character value of 0. There is new terminology in the ICD-10 code set and Introduction/Injection is a good example: Introduction replaces Injections.
  • In the PCS Index, how would you know to go to “Introduction” rather than “Insertion” or Implantation?” Insertion is ruled out because the main term states “Insertion of device in.” In the PCS Index, after locating the main term, “Implantation” there is a subterm, “Insertion.” You know that isn’t going to work because it includes devices.
  • Introduction is defined as “Putting in or on a therapeutic, diagnostic, physiological, or prophylactic substance except blood products.” You may find the definition of “Introduction” in the tables itself, as the definition of the root operations are located on the top of all PCS tables.
  • In ICD-10-PCS, the GI tract has subterms that are divided by Upper GI and Lower GI tracts.
  • How do we know the approach is percutaneous? We know the feeding tube was placed under fluoroscopy. This is known as a radiologically-guided feeding tube placement. A nick is made in the stomach to allow passage of the feeding tube.
  • For the 6th character, substance replace Device in the Administration section; otherwise the remaining characters are the same as those found in the Med/Surg section.

 

Locating the Code(s) by Going Directly to the Tables

Directions for Placement of Naso-gastric Feeding Tube

  1. Step #1 is to locate the correct section in your PCS coding book. Based on the above-referenced explanation, you know you should be in the Administration section. But what if you didn’t know that? Then you would refer to the Table of Contents and look for the heading (in bold), “ICD-10 PCS Tables,” followed by the listing of Administration under this category (p. 429 in the 2015 Optum edition.) If you don’t have coding books, buy them. It is far more difficult to learn ICD-10-CM-PCS coding from encoders. Also note that the first character in the Administration section is always 3.
  2. Step 2: Determine the correct Body System — Physiological Systems and Anatomical Regions. Although there are other values for the second character, such as 0 –Circulatory, and C –Indwelling device, the Body System character value in this particular case is E in the Administration section. This character indicates the general physiological system or anatomical region involved (gastrointestinal, for example.) Thus far, we have identified the first two characters, 3E.
  3. Step 3: Determine the root operation. Ask yourself what the object of the procedure is. The goal is to insert a feeding tube into the stomach. We can safely assume that either a small incision or a prick was made to accommodate the feeding tube. Our root operation is Introduction. We now have the first three characters, 3E0. And this puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives the section, Administration; the body system, Physiological Systems and Anatomical Regions; and it gives the root operation, Introduction.
  4. Step 4: Identify the Body System/Region to determine the 4th character value. The Body System/Region should relate to the root operation. In our scenario the key word is region. Region refers to general rather than specific anatomical sites. PCS divides the GI Tract into Upper/Lower parts. We are in the upper GI tract, the stomach area. We now have 4 character values 3E0G. Coding Tip: There are multiple rows for the table 3E0. The quickest way to locate the correct row is to scan the first column (Body System/Region), looking for the letter G. Don’t stop at the first G you come to because there is more than one G and it must include the Substance administered in the Substance column. If it doesn’t include nutritional substance, then keep looking. We are up to 5 characters, 3E0G3.
  5. Step 5: Determine the Approach. A needle prick is required to accommodate the Introduction of the feeding tube. We should now have 5 characters, 3E0G3.
  6. Step 6: Determine the substance administered. It is a nutritional substance, with a character value of 6. We should now have 3E0G36.
  7. Step 7: There is no qualifier, so we now have our code of 3E0G36Z. Z is the placeholder in ICD-10-PCS.

Last week we stated that from here on we would be coding problems that require assignment of both diagnoses and procedures. With respect to the breakdown of diagnostic codes, a new feature, we will only do that for the PDx.

Problem for this week:  A patient 6-months pregnant was diagnosed with iron-deficiency anemia and was admitted for transfusion of non-autologous packed red blood cells via a peripheral vein.

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key:

O99.012          Anemia complicating pregnancy, second trimester

D50.9              Iron-deficiency anemia, unspecified

30233N1         Transfusion of red blood cells

 

To Locate dx code of anemia complicating pregnancy:  Alphabetic Index > Anemia > complicating pregnancy, childbirth, and puerperium > see Pregnancy complicated by (management affected by), anemia > O99.01- > Go to the Tabular to verify the code and pick up the remaining digit(s) needed to complete this code. A dash following a character is your clue that you haven’t yet finished building the code, and it indicates that another digit is required. That digit is 2 for a code of O99.012. Obstetric codes always begin with the letter O, not to be confused with the number zero.

Breakdown of O99.012

O99 = Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium

O99.0 = Anemia complicating pregnancy, childbirth, and the puerperium

O99.01 = Anemia complicating pregnancy

O99.012 = Anemia complicating pregnancy, second trimester

 

Comments – O99.012

  • 099.012 is assigned as the PDx because the anemia is complicating the pregnancy.
  • Second trimester is assigned because the patient is six months pregnant.
  • ICD-10-CM defines the second trimester as between the range of 14 weeks and 0 days to less than 28 weeks and 0 days. Providers may document the unit of the trimester in either week or months.

To Locate dx code of iron-deficiency anemia:  Alphabetic index > Anemia > deficiency > iron > D50.9 > Locate D50.9 in the Tabular to verify the code.

Comments – D50.9:

  • We know this patient has anemia, but adding code D50.9, iron-deficiency anemia, adds greater specificity as to the type of anemia.

To Locate px, Transfusion of red blood cells:  PCS Index > Transfusion > Vein > Peripheral > Blood > Red Cells > 3023 > Locate table 302, and then go across the row to finish building the code:

Transfusion of Nonautologous Red Blood Cells into Peripheral Vein, Percutaneous Approach

PCS Root Op 48 Comments:

  • The Administration section includes services such as injections, infusions, and transfusions.
  • There are 3 root operations in the Administration section and they are classified according to the broad category of substance administered. For example, blood products are classified to the root operation “Transfusion.”
  • Substance replaces Device as the 6th character value. Device is assigned to the Med/Surg section, not the Administration section.
  • A needle is inserted into the patient’s vein, so the obvious answer for Approach is percutaneous.
  • The substance is packed RBCs. What is the difference between packed RBCs and regular RBCs? In transfusion medicine, packed red blood cells (aka stored packed red blood cells or packed cells) are red blood cells (also called erythrocytes) that have been collected, processed, and stored in bags as blood product units available for blood transfusion.

 

Locating the Code(s) by Going Directly to the Tables

Directions for Blood Transfusion 

  1. Step 1: Locate the correct section in your PCS coding book. Based on the above-referenced explanation, you know you should be in the Administration section. But what if you didn’t know that? Then you would refer to the Table of Contents and look for the heading (in bold), “ICD-10 PCS Tables,” followed by the listing of Administration under this category (p. 429 in the 2015 Optum edition.) If you don’t have coding books, buy them. It is far more difficult to learn ICD-10-CM-PCS coding from encoders. Also note that the first character in the Administration section is always 3.
  2. Step 2:  Determine the correct Body System. The substance is blood, which, in our scenario, is the Circulatory System. The character value for the Circulatory System is always 0. Thus far, we have identified the first two characters, 30.
  3. Step 3:  Determine the root operation. You already know the root operation is transfusion, with a character value of 2. We now have the first three characters, 302. And this puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives us the section, Administration; it gives us the body system, Circulatory; and it gives us the root operation, Transfusion.
  4. Step 4: Identify the body system/region to determine the 4th character value. This is easy. As you probably know, the Body System/Region should relate to the root operation. The Body System/Region is a peripheral vein and the root operation is Transfusion. The area used most frequently to draw blood is a vein. So far we have 4 character values, 3023.
  5. Step 5:  Determine the Approach. This too should be easy. A needle prick is required to draw blood, which is considered a Percutaneous Approach. We now have 5 characters, 30233.
  6. Step 6:  Identify the substance administered, the 6th character value, N. Blood was drawn for transfusion, then prepared for packaging. We’re up to 6 character values, 30233N. Remember, in the Administration section Substance replaces Device.
  7. Step 7:  Qualifiers augment, i.e., tell us more about the procedure. The 7th character value in our scenario is 1, Nonautologous for a code of 30233N1.

For the past several months the Coding Tidbits have focused on procedure coding. With ICD-10-CM and ICD-10-CM-PCS Coding on the horizon (hopefully), from here on out you will be given problems requiring assignment of both diagnostic and procedural codes.

Problem for this week:  A patient was admitted with occlusion of the right common carotid artery due to plaque. An open carotid endarterectomy was carried out with extracorporeal circulation (continuous cardiac output).­­­­­­

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

Answer Key: 

I65.21:  Occlusion and stenosis of right carotid artery

03CH0ZZ:  Extirpation of matter from the right common carotid artery, open approach

5A1221Z:  Performance of cardiac output, continuous (extracorporeal circulation).

 

Problem #1, Occlusion of right common carotid artery for which patient underwent an open carotid endarterectomy accompanied by extracorporeal circulation.

To Locate Dx code:  Alphabetic Index > Occlusion > Artery > Carotid > I65.2 > go to the Tabular to verify the code and see if additional digits/characters are assigned > Occlusion and stenosis of right carotid artery > I65.21.

 

Breakdown of I65.21:

I65 = Occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction

I65.2 = Occlusion and stenosis of carotid artery

I65.21 = Occlusion and stenosis of right carotid artery

 

Problem #1 cont’d

To Locate endarterectomy Px:  PCS Index > Endarterectomy > see Extirpation, upper arteries > Extirpation > Common Carotid > Right > 03CH > locate table 03C and go across the row to finish building the code, making sure that the 4th character listed in the Index is correct:

 

Extirpation of Matter from the Right Common Carotid Artery, Open Approach

PCS Root Ops 47A

Comments:

  • Always start your PCS Index search by going to the root operation – Extirpation.
  • Extirpation is defined as “Taking or cutting out solid matter from a body part.”
  • Our diagnostic statement (coding problem) does not state Internal/External Common Carotid Artery; rather, it states common carotid artery. Don’t be misled by the statement, because the external/internal carotid arteries and the common carotid artery are not the same thing. The External Carotid Artery is a major artery of the head and neck. It arises from the common carotid artery. The Index distinguishes, as subterms, between the common carotid artery, the internal carotid artery and the external carotid artery under Extirpation.
  • The internal carotid artery is a major paired artery one on each side of the head and neck. They arise from the common carotid arteries where these bifurcate into the internal and external carotid arteries
  • The objective of the carotid endarterectomy is to take out or cut out the solid matter (plaque) occluding the carotid artery. Therefore the procedure is coded to the root operation, Extirpation.
  • NOTE:  Directions for locating endarterectomy of the right common carotid artery by directly using the tables are located at the end of this tidbit.

 

Problem #1 cont’d

To Locate Extracorporeal Circulation > PCS Index > There is no listing in the Index for Extracorporeal Circulation. In the Table of Contents, look for Extracorporeal Assistance and Performance found under  “ICD-10 Tables” > go to the correct page (p. #440 for the Optum 2015 edition and there you will find table 5A1 > go across the row to finish building the code:

 

Performance of Cardiac Output, Continuous

PCS Root Ops 47B

Comments:

  • Extracorporeal Circulation is classified to the Extracorporeal Assistance and Performance section.
  • The root operation is Performance because the machine has completely taken over the patient’s cardiac function during the procedure.
  • Note that the 5th character, “Approach” and the 6th character “Device” in the Med/Surg section have been replaced by the 5th character “Duration” and the 6th character “Function” in the Extracorporeal Assistance and Performance section.

 

Locating the Code(s) by Going Directly to the Tables

Directions for Endarterectomy of Right Common Carotid Artery

 

  1. The first thing you should do is determine which section the common carotid artery is located. ICD-10-PCS separates upper arteries from lower arteries. The common carotid artery is of course considered an upper artery. You can either refer to the Table of Contents or you can flip through the PCS coding book to be in the correct section. If you don’t have ICD-10-CM/PCS coding books, it is highly recommended that you buy them. It is far more difficult to learn ICD-10-CM-PCS coding from encoders.
  2. The first character in the Med/Surg section is always 0.
  3. Next determine which Body System you should be in. We determined that in step 1 we are in the Upper Artery Section, which is represented by value a value of 3. We have the first two characters, 0 and 3. In addition, the first 3 characters values are listed for you at the top of the table, 03C, which puts you in the correct table. It gives you the correct section (Med/Surg), the Body System (Upper Arteries), and the Root Operation (Extirpation). So far we have identified the first 3 characters.
  4. After identifying the 4th character, H, the Body Part for the Right Common Carotid Artery you, have only 3 characters left to assign. At no time do you have to assign 7 characters because the tables ALWAYS give you the first 3 character values and sometimes the Index gives you the 4th character value as well. So far we have the character values 03CH.
  5. It isn’t always easy to determine the Approach although in our scenario it’s easy. We know from the diagnostic statement that the Approach was Open. Now we are up to 5 characters, 03CH0.
  6. Because no device was left in place postoperatively, the character value is Z. We now have 6 character values, 03CH0Z.
  7. The 7th and last character value is the Qualifier. Since there is no Qualifier, the character value is Z, placeholder, for a code of 03CH0ZZ

Problem for this week:  Right trigeminal neuralgia for which the patient underwent destruction of the trigeminal nerve. The operation consisted of right sterotactic radiofrequency destruction of the nerve using a radiofrequency needle. The treatment was done 3 times along the clival line of the nerve.

 

 

 

 

 

 

Who We Are

 

 

 

 

Answer Key:  005K3ZZ

To recap, we have spent the last two weeks reviewing the Substance Abuse and Mental Health sections. This week we are going back to random review of procedure(s) in the Med/Surg Section.

 

Problem:  Destruction Trigeminal Nerve

To Locate:  PCS Index > Destruction > Nerve > Trigeminal > 005K > locate table 005 and go across the row to finish building the code, making sure that the body part given in the Index is correct:

Destruction of Trigeminal Nerve, Percutaneous Approach

PCS Root Ops 46

Comments

  • When coding from the Index, always start by looking up the Root Operation first.
  • Destruction is defined as the physical eradication of all or a portion of a body part by the direct use of energy, force, or a destructive agent.
  • Approach:  Since a needle was used to advance the needle to the operative site, this is your clue that the procedure was done percutaneously. A nick is made for needle access, but a nick certainly doesn’t constitute an open procedure.
  • Three treatments were done but we’re only coding the procedure once. The needle was not reintroduced each time and the ablation/destruction was all on the same branch of the trigeminal nerve.

 

Locating the Code(s) by Going Directly to the Tables

Directions for Destruction of Trigeminal Nerve

  1. The first thing you should do is determine which section the trigeminal nerve would most logically be located. Obviously, you want to be in the Nervous System section but which one – Cerebral versus Peripheral Nervous System? If you look up the Root Operation for both Nervous Systems, you will see that there is no listing of destruction in the Peripheral Nervous System section. That leaves only the Central Nervous System. And, of course, you can always refer to the table of contents at the beginning of your PSC coding book. If you do not have a coding book, it is recommended that you buy one. It is far more difficult to learn ICD-10-PCS coding from encoders.
  2. Determine which Body System you should be in. We determined that in step 1 we are in the Central Nervous System. You should be in the correct table. The first 3 characters values are listed for you at the top of the table, 005, gives you the Section, Body system, and Root Operation. So far we have identified the first 3 characters.
  3. We don’t have to locate the root operation, 3rd character, because we established that in step #2. The root operations are arranged alphabetically. We are looking for Destruction, character value of 5.
  4. After identifying the 4th character, K, the Body Part for the trigeminal nerve you, have only 3 characters left to assign. At no time do you have to assign 7 characters because the tables ALWAYS give you the first 3 character values and sometimes the Index gives you the 4th character value as well. So far we have the character values 005K.
  5. It isn’t always easy to determine the Approach although in our scenario it is isn’t that difficult. Since a needle was “introduced,” we know that the Approach is Percutaneous Now we are up to 5 characters, 005K3.
  6. Because no device was left in place postoperatively, the character value is Z. We now have 6 character values, 005K3Z.
  7. The 7th and last character value is the Qualifier. Since there is no Qualifier, the character value is Z, placeholder, for a code of 005K3ZZ.

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