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.
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
- 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
- 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.
- 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.
- 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.
- 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.
- 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.
- Because no device was left in place postoperatively, the character value is Z. We now have 6 character values, 005K3Z.
- 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.