ICD-10-PCS, Root Operations – Part 46, Procedures: Question & Answer

ICD-10-PCS, Root Operations – Part 46, Procedures: Question & Answer

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.

Coding problems for this week:

  1. Individual cognitive therapy.
  2. Electroconvulsive Therapy (ECT), unilateral for multiple seizures.

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key:

  1. GD52ZZZ
  2. GZB1ZZZ

 

Last week we discussed substance abuse procedures. This week we are going to focus on mental health procedures. The structure of both Substance Abuse and Mental Health are very similar. This will be our only discussion on Mental Health. The Mental Health section is relatively small and makes use of only 3 of the PCS. Values in characters 2, 5, 6, and 7 just as is true for Substance Abuse, are always ZZZ, None, and are used as placeholders.

Character 1, Section:  The first character is always G.

Character 2, Body System:  Assign value Z, None. At this time there are no specific characters for the 2nd character field.

Character 3, Root Type:  There are 12 Root Type values in this section, as follows:

  • Psychological Tests (character value of 1)
  • Crisis Intervention (2)
  • Medication Management (3)
  • Individual Psychotherapy (5)
  • Counseling (6)
  • Family Psychotherapy (7)
  • Electroconvulsive Therapy (B)
  • Biofeedback (C)
  • Hypnosis (F)
  • Narcosynthesis (G)
  • Group Psychotherapy (H)
  • Light Therapy (J)

Character 4, Type Qualifier:  There are 25 different Type Qualifiers in this section. They describe the type of treatment indicated by the Root Type specified in character 3. Examples include specific types of Psychological Tests and different types of Individual Psychotherapy.

Characters 5 – 7:  Assign value Z, None. There are no specific characters for the 5th, 6th, and 7th character fields at this time.

 

Problem #1, Individual cognitive therapy.

To Locate:  PCS Index > Psychotherapy > Individual > see Psychotherapy, Individual, Mental Health Services > Cognitive > GZ52ZZZ > Locate Table GZ5 to validate that this code is correct:

Individual Psychotherapy, Cognitive

PCS Root Ops 45A

Comments:

  • This is an easy problem to code because the Index gives us the code. We only have to verify that the 3rd character value of 5 (Root Type), Individual Psychotherapy and the 4th character value of 2 (Type Qualifier), Cognitive, are correct.
  • Remember to go to the Root Type first when coding from the Index.
  • The Index instructs us to see Psychotherapy, Individual, Mental Health Services. The 3rd sub-term under Psychotherapy is “Individual.” However, there is no listing for Individual under Mental Health Services. Just go to Mental Health Services and you’ll see the listing for Cognitive.

 

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

Directions for Individual Cognitive Therapy

  1. How do you know where to start? You can either flip through the coding tables, looking for Mental Health Services or you can go to the Table of Contents where you’ll find a listing for Mental Health Services.
  2. All Mental Health Service procedures begin with the character value of G.
  3. You don’t have to worry about locating the 2nd character value because there is none at this time for the 2nd character field. Instead, look for the Root Type, Individual Cognitive Therapy, keeping in mind that all Root Types are arranged alphabetically. In our scenario, the Root Type has a character value of 5.You should now be in the correct table, GZ5. The first 3 character values are always listed at the top of each table. The table gives us GZ5. Now you have only to verify that the 3rd and 4th character values of 5 and 2 respectively, are correct.
  4. So far we have the character values of GZ52.
  5. In Table GZ5 the 5th, 6th, and 7th characters are left blank at this time, so those characters are assigned to Z. And bingo, we have our code, GZ52ZZZ.

 

Problem #2, Electroconvulsive Therapy (ECT), unilateral for multiple seizures.

To Locate:  PCS Index > Electroconvulsive Therapy > Unilateral-Multiple Seizure > GZB1ZZZ > Even though the Index gives you the code, I still want you to go locate table GZB and verify that the code listed in the Index is correct.

Electroconvulsive Therapy, Unilateral – Multiple Seizure

PCS Root Ops 45B

Comments:

  • Once again the Index gives us the code. Mental Health codes are very simple to solve. You have only two characters to verify, Root Type of B and Type Qualifier of 1.
  • Go to the Root Type first when coding from the Index.
  • As you can see after coding these 2 problems, Mental Health Services coding problems are quite easy to code. In both instances, the Index gave us the entire code. All we had to do was verify that the code is correct by locating the appropriate table(s).
  • We are not going to include directions for coding from the tables because it would be redundant.

Coding Problems for this week:  

  1. Medication monitoring of patient on methadone maintenance.
  2. Group cognitive-behavioral counseling for substance abuse.

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key:  

  1. HZ81ZZZ
  2. HZ42ZZZ

 

For the past couple weeks we have reviewed randomly selected problems from the Med/Surg section and the Placement/Administration/Measurement and Monitoring section. This week we are going to review Substance Abuse Treatment, quite a departure from what we’ve accomplished to date. The Substance Abuse section, similar to the Mental Health section, only makes use of three of the PCS characters. Values in characters 2, 5, 6, and 7 are always Z – None, the placeholder. Because Substance Abuse Treatment Services are so easy to code, this will be our one and only session on this topic. Next week we will discuss the Mental Health Section.

Substance Abuse Therapy:

There are two terms to know when coding substance abuse problems:

  1. Abuse: Problematic use of drugs or alcohol but without dependence.
  2. Dependence:  Increased tolerance to drugs or alcohol with a compulsion to continue taking the substance, despite the cost; withdrawal symptoms often occur upon cessation.

Character Values for Substance Abuse Treatment Section

  • Character 1, Section:  The first character is always H.
  • Character 2, Body System:  Assign value Z, None, for all procedures.
  • Character 3, Root Type:  There are 7 root-type values in this section, differentiated by type of treatment:
    • Detoxification Services
    • Individual Counseling
    • Group Counseling
    • Individual Psychotherapy
    • Family Counseling
    • Medication Management
    • Pharmacotherapy
  • Character 4, Type Qualifier:  Each of the root types referred to above have 12 or 13 different specific types of services associated with them, with the exception of Detoxification and Family Counseling. These root types are represented by the Type Qualifier, 4th character value. I’m not going to list them here, as they are listed in your in the PCS coding book. However, I will give you a few examples:
    • Specific types of counseling and psychotherapy such as Cognitive, Behavioral, Vocational etc.
    • Distinct general categories of Medication and Management and Pharmacotherapy such as Antabuse, Clonidine, Methadone Maintenance, etc.
    • At this time there are no specific valid characters for the 5th, 6th, and 7th- character fields for Substance Abuse Treatment procedures, so assign the value Z for the last three characters.

 

Problem #1, Medication monitoring of patient on methadone maintenance:

To Locate:  PCS Index > Substance Abuse Treatment > Medication Management > Methadone Maintenance > HZ81ZZZ > locate table HZ8 and go across the row to finish building the code. There isn’t much to build but I want you to go to the table to verify the code listed in the Index is correct:

Medication Management for Substance Abuse Treatment, Methadone Management

PCS Root Ops 44A Comments:

  • This is an easy coding problem to solve because the Index gives us the code. We only have to verify that the 3rd character value of 8, Medication Management, and the 4th  character Type Qualifier, Methadone Maintenance, are correct.
  • Remember to go to the Root Type first when coding from the Index.

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

Directions for Methadone Maintenance Management

    1. How do you know where to start? You can either flip through the coding tables, looking for Substance Abuse Treatment or you can go to the Table of Contents where you’ll find a listing for Substance Abuse Treatment.
    2. All Substance Abuse procedures begin with the character value of H.
    3. You don’t have to worry about locating the 2nd character value because there is none at this time for the 2nd character field. Instead, look for the Root Type, Medication Management, keeping in mind that all Root Types are arranged alphabetically. In our scenario, the Root Type has a character value of 8.You should now be in the correct table, HZ8. The first 3 values are always listed at the top of each table. So far you have identified the first 3 character values, HZ8, which puts you in the correct table.
    4. Now you must identify the 4th character value, Type Qualifier, Methadone Maintenance, with a character value of 1. So far we have the character values HZ81.
    5. In Table HZ8 the 5th, 6th, and 7th characters are left blank at this time, so those characters are assigned to Z. And bingo, we have our code, HZ81ZZZ.

 

Problem #2, Group cognitive-behavioral counseling for substance abuse.

To Locate:  PCS Index > Substance Abuse Treatment > Counseling > Group > Cognitive-Behavioral > HZ42ZZZ > locate table HZ4 and go across the row, verifying that the character values listed in the Index for this code are correct:

Group Counseling for Substance Abuse Treatment, Cognitive-Behavioral

PCS Root Ops 44B

Comments:

  • The two problems we did today clearly demonstrate just how easy Substance Abuse Treatment problems are to code.
  • Even if the Index doesn’t list the entire code, there are only 1-2 character values that you have to identify in the table.

 

NOTE

We are not giving directions for locating the codes from the table for Group Counseling because it would redundant. The instructions for problem #2 are almost the same as for problem #1.

Problem for this week:  Esophagogastroscopy with Botox injection into esophageal sphincter.

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

Answer Key:  3E0G8GC

For the past two weeks we have given you randomly selected coding problems. We reviewed a sigmoidoscopy from the Med/Surg section and an arm compression from the Placement section. This week we are going to code a Botox injection from the Administration Section. Administration procedures involve services such as transfusions, infusions, injections, and irrigations, and the first character is always 3. There was an extensive review on the Administration section in the 11/26/14 Tidbit.

To Locate:  PCS Index > Esophagogastroscopy > 0DJ68ZZ > Locate table 0DJ and verify whether the code is correct or not. It is not the correct code. You know right away because the root operation given in this table is Inspection, Not Introduction.  Back to the Index:  Introduction of substance in or on > Gastrointestinal Tract > Upper > All the sub-terms under GI Tract, Upper, lists 3E0G. One of the sub-terms is Diagnostic Substance, Other, but this too is incorrect because this is a therapeutic procedure, not a diagnostic procedure > Locate table 3E0 and go across the row to finish building the code after verifying that the 4th digit listed in the Index is correct:

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

PCS Root Ops 43

Comments:

  • Remember that it is always a good idea to look for the root operation when you start coding a problem. If you went to Esophagogastroscopy, it gives you code 0DJ68ZZ, incorrect for our scenario.
  • Injection is now referred to as Introduction in keeping with some of the new terminology in ICD-10-PCS.
  • Approach:  The scope is inserted through the mouth, a natural opening. The fact that this procedure was done through a scope indicates that this is an endoscopic procedure.
  • Botulinum toxin is a paralyzing agent with temporary effects; it does not sclerose or destroy the nerve.
  • One main difference between the Med/Surg section and the Administration section is that the value for the 6th character is Substance rather than Device. The substance is coded to the character value of G, Other Therapeutic Substance, because there is no listing for Botox.
  • Qualifiers contain unique values for individual procedures. For example, the qualifier can be used to identify the destination site in a bypass, although in our scenario, the qualifier “Other Substance” doesn’t add anything to the clinical picture as far as I can tell.

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

Directions for Botox Injection

  1. How do you know where to start? If you recall that Introduction/Injection procedures are found in the Administration section, you know you’re in the right place. What if you didn’t know that? Then you’d go to the Table of Contents and look for Administration.
  2. All Administrative procedures begin with the character of 3.
  3. Don’t worry about locating the Body System. Instead, look for the Root Operation, keeping in mind that all Root Operations are arranged alphabetically. In our scenario, the Root Operation is Introduction, with a character value of 0. You should now be in the correct table, 3E0. The reason you don’t have to worry about identifying the correct  Body System is because the first 3 character values include the Body System  as well as the Section (Administration), and Root Operation (Introduction). These 3 values are always listed at the top of each table. So far you have identified the first 3 character values, 3E0.
  4. Now you must identify the 4th character value, Body Part, Upper GI, with a character value of G. There are multiple rows that begin with 3E0, so don’t stop at the 1st G you come to because you may not necessarily be in the correct row. Note that table 3E0 only lists Upper and Lower GI. The specific Body part, Esophageal Sphincter, is not listed. When deciding on the selection of the row for 4th character for 3E0G, you may notice there are actually 5 rows with the 4th character, G, to choose from. Looking at the 6th character, “substance,” is an expeditious way to locate the correct coding row. So far we have the character values 3E0G.
  5. Table 3E0 lists three choices for Approach. The scope is entered through the mouth, a natural opening. The fact that this procedure was done through a scope indicates that this is an endoscopic procedure. We are up to 5 characters, 3E0G8 – 8 represents via Natural Opening Endoscopic.
  6. When considering whether to code an inspection procedure, the Medical and Surgical section Guideline B3.11a states that “Inspection of a body part(s) performed in order to achieve the objective of a procedure is not coded separately.” In our case, the esophagogastroscopy was performed in order to reach the main objective of the procedure which is the injection of Botox, so it is not coded separately.
  7. The substance injected or introduced is Botox. Identifying the substance is a snap because Table 3E0 only lists one substance, Other Therapeutic Substance. We now have 6 character values, 3E0G8G.
  8. The 7th and last character value is the Qualifier. Again, we don’t have to make a choice for the Qualifier because the only substance listed is Other Substance, C. W now have our code, 3E0G8GC.

Problem #1:  Placement of intermittent pneumatic device covering entire right arm.

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

Answer Key:  2W18X7Z

 

This week we are going to address a procedure randomly selected from the Placement, Administration, Measurement and Monitoring section. The first character for these sections are:

2 – Placement

3 – Administration

4 – Measurement and Monitoring

 

Types of Procedures Included in this Section:

  • Epidural Injection
  • Intraoperative central nervous system monitoring
  • Application of a plaster cast
  • Cervical traction with traction apparatus
  • Voiding pressure studies associated with a cystometrogram

 

To Locate:  PCS Index > Compression > Arm > Upper > right > 2W1AX > Locate table 2W1 and then look for the body part that covers the entire arm, not just the left or right upper/lower arm > 2W1 > Upper Extremity, Right > 2W1AX > Go across the row to finish building the code after determining whether or not the 4th character, Body Part, is correct:  4th character, A for upper arm is incorrect. Body Part 8, upper extremity, is correct.

 

Compression of Right Upper Extremity Using Intermittent Pressure Device

PCS Root Ops 42 Comments:

  • According to Guideline B2.1a, The procedure codes in the General Anatomical Regions Body Systems should only be used when the procedure is performed on an anatomical region rather than a specific body part (Control, Detachment, Compression). In our scenario, upper/lower arm doesn’t provide sufficient specificity. Given our choices in the Index for compression of the arm, we are only given upper/lower, right/left arm, but nowhere is the entire arm listed. Therefore, the entire arm is considered an Anatomical Region.
  • Guideline B2.1b:  Body Systems designated as upper and lower contain body parts located above or below the diaphragm, respectively. In our scenario, we are in the upper body part.
  • This problem is a good example of why you should not rely solely on the Index. The Index lists Right/Left Lower/Upper Arm, but not the entire arm. After locating table 2W1, verify that the 5 characters listed in the Index are correct.
  • If you looked for Placement – Anatomical Regions – first, you can see that there is no main term for Placement in the Index. It is always a good idea to go the root operation (listed alphabetically) first when coding from the Index and, as you can see, the root operation is Compression. However, there is more than one way to skin a cat and I will talk about that in “Directions for Finding a Code Using the Tables.”
  • Compression is defined as “Putting pressure on an external body regions.”
  • Approach is External (procedures performed directly on the skin). There aren’t any other choices for approach in table 2W1.
  • Device, 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. In our scenario, the device value is 7, Intermittent Pressure Device.

 

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

Directions for Compression Device for Entire Arm

  1. How do you know where compression is located?  If you’re not sure of the correct section, start out by flipping through the various sections in the PCS coding book, looking for the Placement section. All placement procedures begin with the character value of 2.
  2. Determine which Body System you should be in. Once you locate the Placement section, look for the root operation, Compression. The first 3 character values are listed for you at the top of the table, 2W1, which gives you the body system, Anatomical Region, and Root Operation. So far we have identified the first 3 characters. 2W1.
  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 Compression, character value of 1.
  4. After identifying the 4th character, 8, the Body Part for the entire arm 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 2W18.
  5. It isn’t always easy to determine the Approach although in our scenario it is very simple. There is only one choice for Approach in table 2W1. Now we are up to 5 characters, 2W18X.
  6. Since a compression device was left in place postoperatively, the 6th character value is 7. We now have 6 character values, 2W18X7.
  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 2W18X7Z.

This week and for the following few weeks, rather than addressing specific PCS guidelines, I’m giving you a problem from the Med/Surg section, randomly selected. Any guidelines that apply to this problem will, of course, be discussed.

 

Problem for this week:  Colonoscopy, abandoned at sigmoid colon.

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key:  0DJD8ZZ

To Locate:  PCS Index > Sigmoidoscopy > 0DJD8ZZ > go to table 0DJ and verify that the last 3 character values are correct. In addition, verify that the root operation is correct:

Inspection of Lower Intestinal Tract, Via Natural or Artificial Opening Endoscopic

PCS Root Ops 41

Comments:

  • We really got a break with this problem. However, I still want you to locate table 0DJ and go across the row to verify that the character values given in the Index are correct.
  • Guideline B3.3 for Discontinued Procedures:  
    • Method 1:  If the intended procedure is discontinued, code the procedure to the root operation performed. The root operation performed would be located under Sigmoidoscopy.
    • Method 2:  If the procedure is discontinued before any other root operation is performed, code the root operation Inspection of the body part or anatomical region inspected.
      • The root operation in the Index would be located under Inspection.
      • To locate the code:  Inspection > Intestinal Tract > Lower > 0DJD.
      • To determine whether the sigmoid is part of the lower or upper GI tract, refer to Guideline B4.8, which explains that the lower Intestinal tract “includes the portion of the GI tract from the jejunum down to and including the rectum and anus.”
      • Understanding the anatomy for the Digestive System is important for locating codes in the Index or tables.

 

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

Directions for Sigmoidoscopy

  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 sigmoid colon is part of the Gastrointestinal System, 2nd character value of D. So far we have identified the 1st 2 characters, 0D.
  3. Then locate the root operation, 3rd character. The root operations are arranged alphabetically. We are looking for Inspection, character value J. We are now in the correct table, 0DJ.
  4. After identifying the 4th character, D, the Body Part for lower intestinal tract, 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 0DJD.
  5. It isn’t always easy to determine the Approach. However, we know that, unless stated otherwise, the scope is inserted through a natural opening, the anus. Now we’re up to 5 characters, 0DJD8 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 there is no Qualifier, the character value is Z.

Coding problem for this week:  Left axillary lymph node biopsy.

 

 

 

 

 

Who We Are

 

 

 

 

 

Answer Key:  07B60ZX

Two weeks ago we began a discussion on the guidelines for biopsies, 3B.4a: Biopsy procedures are coded using the root operations Excision, Extraction, or Drainage and the qualifier Diagnostic. Today we will focus on Excision.

 

Problem: A sampling of tissue was taken from the left axillary lymph nodes for biopsy. A piece of tissue was cut out of the lymph node and sent to pathology.

To Locate:  PCS Index > Biopsy > see Excision with qualifier Diagnostic > Excision > Lymphatic > Axillary > Left > 07B6 > locate table 07B and go across the row to finish building the code after verifying that the 4th character value of 6 is correct:

Excision of Left Axillary Lymph Node, Open Approach, Diagnostic

PCS Root Ops 40

Comments:

  • How do you know this is an excision rather than another type of biopsy? The problem stated that a sampling of tissue was taken. Remember, in excision procedures only a portion of a body part is cut out. When a lymph node(s) is cut out, the root operation is Excision. When an entire lymph node chain is cut out, the appropriate root operation is Resection.
  • The qualifier DIAGNOSTIC is used to identify excision procedures that are biopsies.

 

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

Directions for Locating Axillary Lymph Node Biopsy 

  1. The majority of PCS codes are located in the Med/Surg section, which is where you should be; 0 is the 1st character value. Med/Surg procedure codes all have a first character value of 0.
  2. Determine which Body System you should be in. We are in the Lymphatic/Hemic Body System with a 2nd character value of 7. So far we have identified the 1st 2 characters, 07.
  3. Then locate the root operation, 3rd character. The root operations are arranged alphabetically. We are looking for Excision, character value B. We are now in the correct table, 07B.
  4. After identifying the 4th character value of 6, the Body Part for the Left Lymphatic, Axillary, 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. So far we have the character values 07B6.
  5. It isn’t always easy to determine the Approach. However, the sampling of tissue was cut out and it is considered an Open procedure. Now we’re up to 5 characters, 07B60 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, 07B60ZX.

Coding Problem for this Week:  Iliac bone marrow biopsy.

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key:  07DR3ZX

 

Last week we began a discussion on the guidelines for biopsies, 3B.4a: Biopsy procedures are coded using the root operations Excision, Extraction, or Drainage and the qualifier Diagnostic. Today we will focus on Extraction.

 

Problem:  Iliac Bone marrow biopsy.

To Locate:  PCS Index > Biopsy > Bone Marrow > see Extraction with qualifier Diagnostic > Extraction > Bone Marrow > Iliac > 07DR > Locate table 07D and go across the row to finish building the code after verifying that the 4th character value of R is the correct body part:

Extraction of Iliac Bone Marrow, Percutaneous Approach, Diagnostic

PCS Root Ops 39

Comments:

  • Extraction: Pulling or stripping out or off all or a portion of a body part by the use of force.
  • The qualifier DIAGNOSTIC is used to identify extraction procedures that are biopsies.
  • Some other examples of Extraction include:
    • Suction D & C (non-OB)
    • Vein stripping
    • Forceps removal of teeth
    • Extraction of fat for grafting
  • Bone marrow biopsies are most often done on the pelvic bone but they may also be done on the sternum.
  • A hollow needle is inserted into the bone. The needle is then twisted and advanced. This motion allows a sample of bone marrow to enter the core of the needle.
  • The qualifier DIAGNOSTIC is used to identify drainage procedures that are biopsies.
  • The approach is Percutaneous because a puncture is made to accommodate insertion of the biopsy needle.
  • Red blood cells are produced in the bone marrow (hematopoiesis). Bone marrow is also a key component of the lymphatic system.

 

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

Directions for Iliac Bone Marrow 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 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. If you know your anatomy, you should know that bone marrow is part of the Lymphatic/Hemic Systems. So far we have identified the first 2 characters, 07.
  3. Then locate the root operation, 3rd character. The root operations are arranged alphabetically. We are looking for Extraction, character value D. We are now in the correct table, 07D.
  4. After identifying the 4th character, R, the Body Part for Bone Marrow, Iliac, 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 07DR.
  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, 07DR3 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, 07DR3ZX.

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.

 

From the Blog

ICD-10-PCS, Root Operations – Part 46, Procedures: Question & Answer

Problem for this week:  Right trigeminal neuralgia for which the patient underwent destruction of thread more