ICD-10-PCS, Root Operations – Part 38, Procedures: Question & Answer

ICD-10-PCS, Root Operations – Part 38, Procedures: Question & Answer

Coding problem for this week:

  1. Fine needle aspiration biopsy of left lower lobe of lung via inserting a thin needle into the tumor.

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key:

  1. 0B9J3ZX

 

For the next 3 weeks we are going to review the PCS coding guidelines for biopsies, focusing on guideline B3.4a, Biopsy procedures. According to this guideline:

Biopsy procedures are coded using the root operations Excision, Extraction, or Drainage and the qualifier Diagnostic. The qualifier Diagnostic is used only for biopsies. Examples: Fine needle aspiration biopsy of lung is coded to the root operation Drainage with the qualifier Diagnostic. Biopsy of bone marrow is coded to the root operation Extraction with the qualifier, Diagnostic. Lymph node sampling for biopsy is coded to the root operation Excision with the qualifier Diagnostic.

For practice, we are going to code the 1st example given in the above-referenced guideline, B3.4a.

 

Problem #1, Fine needle aspiration biopsy of left lower lobe of lung via inserting a thin needle into the tumor.

To Locate:  PCS Index > Biopsy > see Drainage with qualifier Diagnostic > Lung > Lower Lobe > Left > 0B9J > Locate table 0B9 and go across the row to finish building the code after verifying that the 4th character value of J is the correct body part:

Drainage of Left Lower Lung Lobe, Percutaneous Approach, Diagnostic

PCS Root Ops 38

Comments:

  • Definition Drainage: Taking or letting out fluids and/or gases from a body part.
  • The qualifier DIAGNOSTIC is used to identify drainage procedures that are biopsies.
  • Definition Percutaneous: Entry by puncture or minor incision, of instrumentation through the skin or mucous membrane and/or any other body layers necessary to reach the site of the procedure.
  • The approach is considered Percutaneous because a puncture is made in order to insert the needle.

 

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

Directions for Fine Needle Aspiration Biopsy

  1. The majority of PCS codes are located in the Med/Surg section, which is where you should be; 0 is for the 1st character value. If you’re not sure of the correct section, start out by flipping through the various body systems in the Med/Surg section of the coding book.
  2. Determine which Body System you should be in. You know that the lungs are part of the Respiratory System, 2nd character value of B. So far we have identified the 1st 2 characters, 0B.
  3. Then locate the root operation, 3rd character. The root operations are arranged alphabetically. We are looking for Drainage, character value 9. We are now in the correct table, 0B9.
  4. After identifying the 4th character, J, the Body Part for the left lower lobe of lung, 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 first 4 character values. So far we have the character values 0B9J.
  5. It isn’t always easy to determine the Approach. However, we know that a puncture had to be made before the needle could be inserted, so the approach is Percutaneous. Now we’re up to 5 characters, 0B9J3 with 2 character values left to go, Device and Qualifier.
  6. Since no device was used or left in place postoperatively, the 6th character value is Z, the PCS placeholder.
  7. The 7th and last character value is the Qualifier. Since a biopsy was done, assign X to indicate that the procedure is diagnostic. Now we have our code, 0B9J3ZX.

 

Character Meanings for the Medical and Surgery Section (0)

A review of the character meanings in the Med/Surg section should be helpful. We are not planning to post this table every week but you can always find it on our website tidbit blog. Look for the tidbit dated 3/26/15. 

PCS Med-Surg Character Table 38 

Coding problem for this week, 3/16/15:  Destruction of left sigmoid lesion and bypass of left sigmoid colon via insertion of scope through the anus and then up to the targeted site. The Approach for both Destruction and Bypass are via Natural or Artificial Opening, Endoscopic.

 

 

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

 

 

 

 

Answer Key:  0D5N8ZZ; 0D1N8ZN

 

Guideline B3.2.c. – Multiple root operations with distinct objectives are performed on the same body part. For example, Destruction of sigmoid lesion and bypass of sigmoid colon are coded separately.

 

Problem, Part 1, Destruction of left sigmoid lesion:

To Locate:  PCS Index > Destruction > Intestine > Large > Left > 0D5N > Locate table 0D5 and then go across the row to complete the code. Before we go on, I want to point out how important it is to validate the 4th character listed in the Index. In our scenario, the 4th character value is G. This is incorrect. Once you locate the table you will see that there is a more specific choice than the left large intestine:  N for sigmoid colon. Then go across the row to finish building the code:

Destruction of Sigmoid colon, Via Natural or Artificial Opening Endoscopic

PCS Root Ops 37A

Comments:

  • Destruction:  Physical eradication of all or a portion of a body part.
  • None of the body part is physically taken out because it has been destroyed. There is nothing left to remove and therefore, nothing left to biopsy.
  • When the site of the procedure is around or surrounding a body part, the procedure is coded to the body part named. We coded it to the sigmoid colon, which is the body part named.
  • Coding sigmoid lesion destruction is a bit tricky. The Index doesn’t list destruction of a sigmoid lesion; it only gives us the sigmoid colon. If you’re using 3M and go to lesion destruction, it will also send you to destruction of sigmoid colon. This is a good example of when we have to rely on the diagnosis code to indicate that it is a lesion that was destroyed, not the entire sigmoid colon.

 

PROBLEM, PART 2:  Bypass of left sigmoid colon.

To Locate:  PCS Index > Bypass > Colon > Sigmoid > 0D1N > Locate table 0D1 and go across the row to finish building the code:   

PCS Root Ops 37B Comments:

  • Bypass:  Altering the route or passage of the contents of a tubular body part.
  • The only difference between the two codes is the root operation. We have multiple root operations, Destruction and Bypass for the same body part, the sigmoid colon.

 

 

Locating the Codes by Going Directly to the Tables

Directions for Destruction of Lesion of Sigmoid Colon

  1. Make sure you’re in the correct section. This shouldn’t be too much of an issue because the majority of the codes will be in the Medical/Surgical section.
  2. Determine which Body System you should be in. We are in the Gastrointestinal Body System. So far we have identified the 1st two characters, 0 (Med/Surg) and Body System (D).
  3. Then look for the Root Operation, 3rd character. The root operations are arranged alphabetically. We are looking for Destruction, character value 3. Now we are in the correct table, 0D5.
  4. After identifying the 4th character, N, the Body Part for the sigmoid colon, you only have 3 characters left to assign. So far we have the character values, 0D5N.
  5. It isn’t always easy to determine the approach, although it is in this instance because the problem states that the Approach is Via Natural or Artificial Opening, Endoscopic, 8.
  6. Now we’re up to 0D5N8 with 2 characters values left to go, the values for characters 6 and 7. Since no device was used or left in place postoperatively, the 6th character value is Z.
  7. We’re almost done – 0D5N8Z so far. There is no indication that a qualifier is needed, so bingo – we now have our code, 0D5N8ZZ.

 

We are going to continue our discussion on guidelines for multiple procedures, Guidelines B3.2.a – 3B.2.d. This week’s discussion focuses on guideline B3.2.b.

 

Coding problem for this week:  Excision of the right sartorius muscle and excision of the right gracilis muscle, Open approach.

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

Answer Key:

0KBQ0ZZ x 2

 

Guideline B3.2.b. – Multiple Procedures:  The same root operation is repeated at different body sites that are include in the same body part value:

 

Problem:  Excision of the right sartorius muscle and excision of the right gracilis muscle, Open approach.

Problem, Part I, To Locate Sartorius Muscle:  PCS Index > Excision > Muscle > Upper Leg, Right > 0KBQ > locate table 0KB and go across the row to finish building the code:

Excision of Right Upper Leg Muscle, Open Approach

PCS Root Ops 36A+36B

Comments:

  • The Sartorius muscle is a two joint muscle.
  • The Sartorius muscle is the longest muscle in the human body – is a long thin muscle that runs down the length of the thigh in the anterior compartment.
  • When coding from the Index rather than the tables, always start with the Root Operation.
  • Note that neither the PCS Index nor the tables identify specific muscles.

 

Problem, Part 2, To Locate Gracilis muscle:  PCS Index > Excision > Muscle > Upper Leg, Right > 0KQB > Locate table 0KB and then go across the row to complete the code:

Excision of Right Upper Leg Muscle, Open Approach

PCS Root Ops 36A+36B Comments

  • The gracilis muscle is the most superficial muscle on the medial side of the thigh.
  • As you can see, the answers for excision of the sartorius and gracilis muscles are the same. Since that is the case, why are we coding it twice? Because, in our Scenario, PCS does not distinguish between the muscles in the legs. The Index lists Upper/Lower leg muscles, right or left and that’s it. Also:
    • Because, according to the guideline, two separate muscles are excised that share the same root operation, Excision, B.
    • Because the sartorius and gracilis muscles are two different body sites but they share the same body part value, Q.

Locating the Codes by Going Directly to the Tables

  1. Make sure you’re in the correct section. This shouldn’t be too much of an issue because the majority of the codes will be in the Medical/Surgical section.
  2. Determine which Body System you should be in. We are in the Muscles Body System. So far we have identified the 1st two characters, 0 (Med/Surg) and Body System (K).
  3. Then look for the Root Operation, 3rd character. The root operations are arranged alphabetically. We are looking for Excision, character 3. Now we are in the correct table, 0KB.
  4. The index gave you the 4th character value, Q. After validating that the 4th character is correct, you only have 3 characters left to assign. So far we have the character values, 0KBQ.
  5. It isn’t always easy to determine the approach, though it is in this instance, 0 for Open.
  6. Now we’re up to 0FBQ0 with 2 characters values to go, the values for characters 6 and 7. Since no device was used or left in place postoperatively, the 6th character value is Z.
  7. We’re almost done – 0FBQ0Z so far. There is no indication that a qualifier is needed, so bingo – we now have our code, 0FBQ0ZZ.

Coding problem for this week:

  1. Diagnostic excision of left lobe of liver and pancreas, percutaneous approach.

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

Answer Key:

  1. 0FB23ZX, 0FBG3ZX

 

Last week we began a discussion on guidelines for multiple procedures, guidelines B3.2.a – B3.2.d.   We will continue to focus on these guidelines for the next few weeks.

Guideline B3.2.a: During the same operative episode multiple procedures are coded if

the same root operation is performed on different body parts as defined by distinct values of the body part character. For example, diagnostic excision of the liver and pancreas are coded separately.

 

Problem #1 Part 1, Diagnostic excision of left lobe of liver and pancreas, percutaneous approach.

To Locate Liver, Part I:  PCS Index > Biopsy > see Excision with qualifier Diagnostic > Liver > Left Lobe > 0FB2 > Locate table 0FB and go across the row to complete the code:

Excision of Left Lobe of Liver, Percutaneous Approach, Diagnostic

PCS Root Ops 35A

Comments:

  • The Qualifier X, Diagnostic, tells us that this procedure was done for the purpose of obtaining a biopsy of the liver.
  • Another indication that this is a diagnostic procedure is to apply the definition of excision: “Cutting out or off, without replacement, a portion of a body part.”

 

Problem #1 cont’d, To Locate Pancreas, Part 2:  PCS Index > Biopsy > see Excision with qualifier Diagnostic > 0FBG > Locate table 0FB and go across the row to finish building the code:

Excision of Pancreas, Percutaneous Endoscopic Approach, Diagnostic

PCS Root Ops 35B

Comments

  • The same root operation, Excision, applies to both the liver and the pancreas.
  • Even if you aren’t familiar with the new definition of Excision, common sense tells you that two procedures are required to complete the clinical picture as captured by the assigned codes.
  • The procedures have the following in common:  Same root operation, Excision; same Approach, Percutaneous; same Qualifier, Diagnosticc.

To Locate procedures using the tables rather than referring or relying on the PCS Index:

I have not devoted very much space to locating procedures by using the tables rather than the Index. However, it is important to develop a comfort level with the tables so you can go to them directly, bypassing the Index altogether. We will begin by locating diagnostic excision of the liver:

Diagnostic excision of the liver:

  1. Make note of the fact that the first 3 characters of any code is located at the top of each table. Therefore, you are only responsible for assigning the last 4 characters of the code.
  2. The first thing you should do is make sure you’re in the correct section of the coding book (Med/Surg, various body systems such as the ones in our scenario, Hepatobiliary ‘system and Pancreas.)
  3. After you locate the Hepatobiliary System and Pancreas, look for the root operation. The root operations are listed in alphabetical order and in our scenario, the root operation is Excision. Now you are in the correct table.
  4. Now look for what is excised, the Body Part. In our scenario, the Body Part is the liver.
  5. Determine the Approach – in our scenario, the approach is Percutaneous, not Percutaneous Endoscopic. All we know is that the procedure was done percutaneously in which a puncture is made.
  6. Determine whether a device was inserted. Only code devices that remain in the body postoperatively.
  7. Finally, determine if a Qualifier is needed to complete the code. Qualifiers contain unique values for individual procedures. In our scenario, for example, the Qualifier X, Diagnostic, is used to identify the fact that this was a biopsy, ie, a diagnostic procedure.

Today we are going to discuss when it is appropriate to assign more than one code to a procedure when it is done under the same episode of care.

This week’s coding problem

  1. Attempted laparoscopy with ablation of endometrium was made. However, due to some unexpected complications, this procedure had to be converted to open ablation of endometrium.

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key

  1. 0U5B0ZZ; 0UJD4ZZ

 

Problem #1, Part 1:  An attempted laparoscopy with ablation of endometrium was made. However, due to some unexpected complications, this procedure had to be converted to open ablation of endometrium.

  • To Locate Part 1: PCS Index > Ablation > see Destruction > Endometrium > 0U5B> Locate table 0U5 and go across the row to finish building the code:

Destruction of Endometrium, Open Approach

PCS Root Ops 34A

Comments:

  • If you know that ablation is a form of destruction, don’t waste your time by going to Ablation first.
  • 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.”
  • Guideline B3.2.d.:  During the same operative episode, multiple procedures are coded if:
    • The intended root operation is attempted using one approach, but is converted to a different approach. Code both the discontinued procedure to the root operation performed and the definitive procedure. We are coding the definitive procedure first. The procedure started out using a laparoscope but had to be converted to an open approach to complete destruction of the endometrium.
    • The above-referenced table is coded to open approach.
  • Since we have to code the discontinued laparoscopy based on guideline B.3.2.d., here we go:
  • To Locate, Part 2:  PCS Index > Inspection > Uterus > 0UJD > Locate table 0UJ and go across the row to finish building the code.

 

Inspection of Uterus, Percutaneous Endoscopic Approach

PCS Root Ops 34B

Comments:

  • This is the first part of the procedure in which they inserted the laparoscope.
  • The approach is Percutaneous Endoscopic because a laparoscope was used.
  • Inspection is one of the new terms and is defined as visually and/or manually exploring a body part.

 

Last week we stated that we would not continue our discussion of procedures in the Administrative section after 2/10/15. However, we are behind schedule so for this week only, we are going to do some more review of procedures coded to the Administrative section.

 

Problems for this week:

  1. Esophagogastroscopy with Botex injection into esophageal sphincter.
  2. Sclerotherapy of brachial plexus lesion, alcohol injection.

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

Answer Key:

  1. 3E0G8GC
  2. 3E0T3TZ vs 0153

 

Problem #1, Esophagogastroscopy with Botox injection into esophageal sphincter.

To Locate:  PCS Index > Introduction of substance in or on > Gastrointestinal tract > Upper > Destructive Agent > 3E0G > Locate table 3E0 and go across the row to finish building the code:

Introduction of Other Therapeutic Substance into Upper GI, via Natural or Artificial Opening Endoscopic

ICD-10 Root Ops Part 33A

Comments:

  • When you have to scan several rows until you come to the correct row, first look for the 4th character value, ‘G’ under the appropriate Root Operation, Introduction. And don’t necessarily stop at the first row you come to that has the 4th character value you are looking for as it may not contain the remaining character values, 5 – 7 —- keep looking.
  • Introduction is part of the new terminology for ICD-10-PCS. In ICD-9-CM, Introduction is referred to as Injection.
  • When coding procedures in the Administration section, the approach is usually Percutaneous. In our scenario the scope is entered through a natural opening, hence a character value of 8 is assigned to account for the endoscope as well as to account for its insertion via a natural opening.
  • The substance is Botox but ICD-10-PCS does not have a code for Botox, at last in this instance; hence, “Other Therapeutic Substance” is assigned; likewise for 7th character, C, “Other substance.” Some examples include anti-infectives, anti-neoplastics, etc.
  • Botulinum toxin is a paralyzing agent with temporary effects; it does not sclerose or destroy the nerve.

 

Problem #2, Sclerotherapy of brachial plexus lesion, alcohol injection.

To Locate:  PCS Index > Introduction of substance in or on > Nerve > Plexus > Destructive Agent > 3E0T3TZ > Locate table 3E0 and after locating the appropriate row, continue across the row to validate that the code given in the Index is correct.

Introduction of Destructive Agent into Peripheral Nerves and Plexi, Percutaneous Approach 

ICD-10 Root Ops Part 33B

Comments:

  • The brachial plexus is a network of nerves that originate in the neck region and branch off to form most of the other nerves that control movement and sensation in the upper limbs, including the shoulder, arm, forearm, and hand. The radial, median, and ulnar nerves originate in the brachial plexus.
  • When you see “Introduction” or “Injection,” you know that a puncture was made, hence the approach is percutaneous.
  • Just as our first problem didn’t have a code for Botox, ditto for this problem – there is no code for alcohol. However, we know that alcohol is used as a destructive agent to deaden nerves.

We have been focusing on procedures in the Administration section for the past few weeks. This will be our last week to discuss procedures in this section.

Problems for this week

  1. Epidural blood patch
  2. Transfusion of embryonic stem cells into central vein.
  3. Infusion of chemotherapy peripheral vein insertion.

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key

  1. 3E0S3GC
  2. 30243AZ
  3. 3E03305

 

Problem #1, Epidural blood patch.

To Locate:  PCS Index > Introduction of substance in or on > Epidural Space > 3E0S3GC >

Locate table 3E0 and then scan the rows, looking for the character value S. Although it doesn’t

apply to this scenario, don’t necessarily stop at the first 4th character value you come to in a

particular row. Also remember that you have to stay within the same row. At any rate, we got a

break again, with the Index giving us the entire code. You should still locate the appropriate row

in table 3E0 and go across the row to validate that the code listed in the Index is correct:

Introduction of Other Therapeutic Substance into Epidural Space, Percutaneous Approach

PCS Root Ops 32A

Comments:

  • An epidural blood patch is a surgical procedure that uses auatologous blood in order to close one or many holes in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture. The procedure can be used to relieve post dural puncture headaches caused by a spinal tap.
  • How it works:  A small amount of the patient’s blood is injected into the epidural space near the site of the original puncture; the resulting blood clot blood then “patches” the meningeal leak. An epidural needle is inserted into the epidural space at the site of the cerebrospinal fluid leak and blood is injected. The clotting factors of the blood close the hole in the dura.
  • It is also postulated that the relief of the headache after an epidural blood patch is due to more of a compression effect than sealing the leak. Because the fluid column in the lumbar spine is continuous with the fluid around the brain, the blood exerts a “squeeze” and relieves the low pressure state in the head.
  • By now you should be sufficiently aware of some of the new terminology, eg, Introduction is the new term for Injections.

 

Problem #2, Transfusion of embryonic stem cells into central vein.

To Locate:  PCS Index > Transfusion > Vein > Central > Stem Cells > Embryonic > 302 > Locate table 302 and go across the row to finish building the code:

Transfusion of Embryonic Cells into Central Vein, Percutaneous Approach

PCS Root Ops 32B

Comments:

  • There are 3 body system (character 2) values in this section:  Circulatory (0), Indwelling Device (C) and Physiological Systems and Anatomical Regions (E).
  • Blood products are classified to the root operation “Transfusion”; Cleansing substances are classified to  “Irrigation.” All other therapeutic, diagnostic, nutritional, physiological, or prophylactic substances administered are classified to “Introduction.”
  • Catheter utilization to introduce substances into the circulatory system is classified to the Percutaneous approach.

 

Problem #3, Infusion of chemotherapy peripheral vein insertion.

To Locate:  PCS Index > Introduction of substance in or on > Vein > Peripheral > Antineoplastic > 3E03 > locate table 3E0 and go across the row to finish building the code:

Introduction of Other Antineoplastic Peripheral Vein, Percutaneous Approach

PCS Root Ops 32C

Comments:

  • Remember that character value 3 is always used for the Administration section.
  • It is very tempting to go to Infusion in the Index. If you do, it will send you to Introduction. Antineoplastics are therapeutic and therapeutic substances are classified to Introduction.
  • By now you know that the approach in the Administration section is almost always going to be Percutaneous. This approach is used for intradermal, subcutaneous, and intramuscular injections.
  • Qualifiers carry additional information for a particular procedure; in this in instance all we know is that chemotherapy was administered.

We have spent the last two weeks focusing on procedures in the Administration section. We’ll continue on the same topic this week. I haven’t yet mentioned that cast application, cervical traction, and cystometrograms are also considered Administrative procedures.

 

Coding problems for this week:

  1. Percutaneous irrigation of ankle joint.
  2. Administration of a hepatitis B vaccine, IM.
  3. Peritoneal dialysis via indwelling catheter.

 

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key

  1. 3E1U38Z
  2. 3E0234Z
  3. 3E1M39Z

 

Problem #1, Percutaneous irrigation of ankle joint.

To Locate:  PCS Index > Irrigation > Irrigating Substance > 3E1U38Z > Locate table 3E1 and go across the row to validate that the code listed in the Index is correct:

Irrigation of Joints Using Irrigating Substance, Percutaneous Approach

PCS Root Ops 31A

Comments:

  • Root Operation: Irrigation is defined as “Putting in or on a cleansing liquid substance.” Some examples include Peritoneal dialysis via indwelling catheter, percutaneous irrigation of knee joint, and gastric lavage.
  • Approach:  A puncture is made to access the knee joint, so the obvious answer is Percutaneous. Making it even easier is the fact that table 3E1 only lists one approach, Percutaneous.
  • Qualifier:  You have two choices in table 3E1 for the Qualifier, either Diagnostic or No Qualifier. I opted for the latter because there is no indication that this procedure was done for biopsy purposes. It was done to clean the area out.

 

Problem #2, Administration of a hepatitis B vaccine, IM.

To Locate:  PCS Index > Introduction of substance in or on > Muscle > Vaccine > 3E0234

Introduction of Serum, Toxoid and Vaccine into Muscle, Percutaneous Approach

PCS Root Ops 31B

Comments:

  • You got a break with this one because the Index gave you the whole code. However, you should still verify it by going to the appropriate row in the tables section.
  • The approach value for intradermal, subcutaneous, and intramuscular Introduction (ie, Injections) is always Percutaneous.

 

Problem #3, Peritoneal dialysis via indwelling catheter.

To Locate:  PCS Index > Irrigation > Peritoneal Cavity > Dialysate > 3E1M39Z > Locate table 3E1 and then go across the row to validate that the code listed in the Index is correct:

Irrigation of Peritoneal Cavity Using Dialysate, Percutaneous Approach

PCS Root Ops 31C

Comments:

  • I always advise you to go to the Root Operation when you start your Index search. However, there’s usually more than one way to skin a cat. If you refer to the main term Dialysis and the sub-term Peritoneal, it also gives you the same code, 3E1M39Z. Not every procedure is listed in the Index. When this happens, what are you going to do? You’ll need to go directly to the tables. This is why its important to develop a comfort level with the tables. So here we go:
      1. Locate the Administration section in the PCS-10 coding book.
      2. Locate the Root Operation, Irrigation (every table lists the Root Operation alphabetically.)
      3. You should now be in the correct table, 3E1.
      4. Continue across the row to assign the remaining 4 character values.
  • Irrigation is defined as “Putting in or on a cleaning substance.” Dialysis is a process for removing waste (diffusion) and excess water (ultrafiltration) from the blood and is used primarily as an artificial replacement for lost kidney function in people with renal failure. In other words, dialysis cleans the blood by removing the waste products such as urea and creatinine.
  • Approaches involving catheterization are coded to Percutaneous.

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.

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